Prescription Drug Store

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

004067 Issued in MO

Legal business name

PRESCRIPTION DRUG STORE

Practice address

308 E Main St
Hayti, MO 63851-1639

Phone

(573) 359-0008

Fax

(573) 359-6376

NPI assigned

Jun 21, 2006

Organization subpart

Yes

Parent organization

JERRY KELLY DUDLEYAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shane Dudley

Title

Owner/Pharmacist

Phone

(573) 359-0009

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prescription Drug Store #2 Other name

Part of

The Prescription Drug

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616544000000",
    "number": "1235175100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 E MAIN ST",
            "city": "HAYTI",
            "state": "MO",
            "postal_code": "638511639",
            "telephone_number": "573-359-0008",
            "fax_number": "573-359-6376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 E MAIN ST",
            "city": "HAYTI",
            "state": "MO",
            "postal_code": "638511639",
            "telephone_number": "573-359-0008",
            "fax_number": "573-359-6376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCRIPTION DRUG STORE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JERRY KELLY DUDLEY",
        "enumeration_date": "2006-06-21",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "573-359-0009"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "004067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600126114",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prescription Drug Store #2",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Prescription Drug Store #2",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Pemiscot Memorial Health Systems
• Craig M Perkins Jr.
• Savannah Leeann Perkins
• Mary Hannah Pierce, FNP- C
• Cody Garrett Pikey I
• Prescription Drug Store
• Debra Radin
• Janna Raney, F.N.P.
• Rayetta Smith Dba Smith and Associates Home Care
• Christina M Redden

• Community/Retail Pharmacy in Hayti, MO
• Providers in Hayti, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.