Provider Demographics
NPI:1447597968
Name:RUDOLPH, DENNIS DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:DEAN
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 HARROW TER
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-5467
Mailing Address - Country:US
Mailing Address - Phone:941-524-6408
Mailing Address - Fax:
Practice Address - Street 1:5404 HARROW TER.
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241
Practice Address - Country:US
Practice Address - Phone:941-524-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist