Provider Demographics
NPI:1679858906
Name:STUCKENSCHNEIDER, RODNEY G (RPH)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:G
Last Name:STUCKENSCHNEIDER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:ROD
Other - Middle Name:G
Other - Last Name:STUCKENSCHNEIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9 TUPELO PARC CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6602
Mailing Address - Country:US
Mailing Address - Phone:636-379-4131
Mailing Address - Fax:636-339-4124
Practice Address - Street 1:9495 MEXICO RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5547
Practice Address - Country:US
Practice Address - Phone:636-379-4131
Practice Address - Fax:636-379-4124
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist