Provider Demographics
NPI:1164412938
Name:RUDZINSKI, MICHAEL (PA; RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:RUDZINSKI
Suffix:
Gender:M
Credentials:PA; RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1044
Mailing Address - Country:US
Mailing Address - Phone:716-876-1337
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29662183500000X
NY1220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant