Provider Demographics
NPI:1013216209
Name:RUDERMAN, YEVGENIY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:YEVGENIY
Middle Name:
Last Name:RUDERMAN
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 1:7 CIRCLE LN
Mailing Address - Street 2:APT. 24E
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-2217
Mailing Address - Country:US
Mailing Address - Phone:518-729-2918
Mailing Address - Fax:
Practice Address - Street 1:7 CIRCLE LN
Practice Address - Street 2:APT. 24E
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-2217
Practice Address - Country:US
Practice Address - Phone:518-729-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist