Healthcare Provider Details

I. General information

NPI: 1871986935
Provider Name (Legal Business Name): STEVE KUDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PACK ST
MOUNDRIDGE KS
67107-8854
US

IV. Provider business mailing address

200 E PACK ST
MOUNDRIDGE KS
67107-8854
US

V. Phone/Fax

Practice location:
  • Phone: 620-345-8650
  • Fax: 620-345-6312
Mailing address:
  • Phone: 620-345-8650
  • Fax: 620-345-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13961
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: