Provider Demographics
NPI:1477076875
Name:RUDESEAL, CHARIS HOPE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CHARIS
Middle Name:HOPE
Last Name:RUDESEAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W 2ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-2973
Mailing Address - Country:US
Mailing Address - Phone:770-846-0202
Mailing Address - Fax:
Practice Address - Street 1:633 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2359
Practice Address - Country:US
Practice Address - Phone:770-748-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist