Provider Demographics
NPI:1790979276
Name:STRAUB, DENNIS R
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:STRAUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CHEROKEE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3646
Mailing Address - Country:US
Mailing Address - Phone:660-886-5558
Mailing Address - Fax:660-886-7000
Practice Address - Street 1:941 CHEROKEE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3646
Practice Address - Country:US
Practice Address - Phone:660-886-5558
Practice Address - Fax:660-886-7000
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist