Provider Demographics
NPI:1003177734
Name:RUDNICK, JENNIFER A (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:RUDNICK
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 1:2936 S 93RD PLZ APT 14
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2825
Mailing Address - Country:US
Mailing Address - Phone:402-740-8770
Mailing Address - Fax:
Practice Address - Street 1:5020 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1196
Practice Address - Country:US
Practice Address - Phone:402-477-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist