Provider Demographics
NPI:1477384691
Name:CADWALLADER, CAREY L
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:L
Last Name:CADWALLADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 BUNKER RD
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-4872
Mailing Address - Country:US
Mailing Address - Phone:573-539-9652
Mailing Address - Fax:
Practice Address - Street 1:1802 S BUSINESS 54
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1786
Practice Address - Country:US
Practice Address - Phone:573-392-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013036244183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician