Provider Demographics
NPI:1275069528
Name:RUDDUCK, STACY KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:KAY
Last Name:RUDDUCK
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 1:7625 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8632
Mailing Address - Country:US
Mailing Address - Phone:614-923-2340
Mailing Address - Fax:614-923-2288
Practice Address - Street 1:7625 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8632
Practice Address - Country:US
Practice Address - Phone:614-923-2340
Practice Address - Fax:614-923-2288
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033186741835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care