Provider Demographics
NPI:1932241536
Name:TADRUS, CHRISTIAN S (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:S
Last Name:TADRUS
Suffix:
Gender:M
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-0957
Mailing Address - Country:US
Mailing Address - Phone:660-263-0909
Mailing Address - Fax:660-263-3514
Practice Address - Street 1:530 E. 24 HIGHWAY
Practice Address - Street 2:(26-39586)
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270
Practice Address - Country:US
Practice Address - Phone:660-263-6710
Practice Address - Fax:660-263-2269
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO44591183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO359147618Medicaid