Provider Demographics
NPI:1225548969
Name:RUDOLF, DEBORAH H (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:H
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 PROSPECT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-3605
Mailing Address - Country:US
Mailing Address - Phone:860-623-1407
Mailing Address - Fax:
Practice Address - Street 1:67 PROSPECT HILL RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-3605
Practice Address - Country:US
Practice Address - Phone:860-623-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0015998183500000X
WA60758350183500000X
IDP7808183500000X
CT6093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist