Prescription Drug Store
NPI 1235175100 · Community/Retail Pharmacy · Hayti, MO
Enrolled with Medicare as Part B Supplier - Mass Immunization (roster Biller Only) · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1235175100
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Parent organization
- Jerry Kelly Dudley
- Organization subpart
- Yes
- Authorized official
- Shane Dudley, Owner/Pharmacist(573) 359-0009
- License
- 004067 (MO)
Specialties & taxonomies
Suppliers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Other name
- Prescription Drug Store #2
- Other name
- Prescription Drug Store #2
Registry dates
- Enumerated
- 2006-06-21
- Last updated
- 2021-03-24
- Certified
- 2021-03-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.