1932241536 NPI number — DR. CHRISTIAN S TADRUS PHARM.D.

Table of content: DR. CHRISTIAN S TADRUS PHARM.D. (NPI 1932241536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932241536 NPI number — DR. CHRISTIAN S TADRUS PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TADRUS
Provider First Name:
CHRISTIAN
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932241536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 957
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBERLY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65270-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-263-0909
Provider Business Mailing Address Fax Number:
660-263-3514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 E. 24 HIGHWAY
Provider Second Line Business Practice Location Address:
(26-39586)
Provider Business Practice Location Address City Name:
MOBERLY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-263-6710
Provider Business Practice Location Address Fax Number:
660-263-2269
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  44591 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P0018X , with the licence number: 44591 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 359147618 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com