Provider Demographics
NPI:1730637604
Name:MAGRUDER, ALICYN GRACE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ALICYN
Middle Name:GRACE
Last Name:MAGRUDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9079 SHELBY 529
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:MO
Mailing Address - Zip Code:63437-3520
Mailing Address - Country:US
Mailing Address - Phone:660-699-2432
Mailing Address - Fax:660-699-3873
Practice Address - Street 1:214 N GRAND ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:MO
Practice Address - Zip Code:63437-1604
Practice Address - Country:US
Practice Address - Phone:660-699-2432
Practice Address - Fax:660-699-3873
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016021595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist