Provider Demographics
NPI:1609377209
Name:RUDER, SETH (RPH)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:RUDER
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 1:16173 W 163RD PL
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-7303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4701 MISSION RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1635
Practice Address - Country:US
Practice Address - Phone:913-831-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027492183500000X
KS1-17027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist