Provider Demographics
NPI:1437432473
Name:DUDENHOEFFER, KEVIN JOHN (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOHN
Last Name:DUDENHOEFFER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SUMMER TREE PL
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1746
Mailing Address - Country:US
Mailing Address - Phone:573-291-9891
Mailing Address - Fax:573-556-8749
Practice Address - Street 1:900 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3894
Practice Address - Country:US
Practice Address - Phone:573-556-5615
Practice Address - Fax:573-556-8749
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist