Healthcare Provider Details

I. General information

NPI: 1477384691
Provider Name (Legal Business Name): CAREY L CADWALLADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S BUSINESS 54
ELDON MO
65026-1786
US

IV. Provider business mailing address

193 BUNKER RD
ELDON MO
65026-4872
US

V. Phone/Fax

Practice location:
  • Phone: 573-392-1863
  • Fax:
Mailing address:
  • Phone: 573-539-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2013036244
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: