NPIMap

Organization Active NPI

Prescription Drug Store

  • Durable Medical Equipment & Medical Supplies
  • Caruthersville, MO
National Provider Identifier
1952554693
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PRESCRIPTION DRUG STORE
Doing business as
Prescription Drug Store
Practice address
410 Ward Ave
Caruthersville, MO 63830-1451
Phone
(573) 333-4890
Fax
(573) 333-0306
NPI assigned
Oct 28, 2008
Last updated
Apr 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PRESCRIPTION DRUG STORE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Authorized official

Name
Shane A DudleyNPI 1154455673
Title
Owner
Phone
(573) 333-4890

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

410 Ward Ave
Caruthersville, MO 63830-1451

Mailing address

410 Ward Ave
Caruthersville, MO 63830-1451
Phone (573) 333-4890

Other identifiers 1

IdentifierTypeStateIssuer
620126102MedicaidMO

Other names 1

  • Prescription Drug Store Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prescription Drug Store3 organizations share this tax ID, including this one
Part of
Prescription Drug Store

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

410 Ward Ave
Caruthersville, MO 63830
Phone (573) 333-4890

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1952554693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 WARD AVE",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638301451",
            "telephone_number": "573-333-4890",
            "fax_number": "573-333-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 WARD AVE",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638301451",
            "telephone_number": "573-333-4890",
            "fax_number": "573-333-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCRIPTION DRUG STORE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESCRIPTION DRUG STORE LLC",
        "enumeration_date": "2008-10-28",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-333-4890"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620126102",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prescription Drug Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prescription Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caruthersville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.