Provider Demographics
NPI:1639223167
Name:SITES, RUDY RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUDY
Middle Name:RAY
Last Name:SITES
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 1:700 LOUGHS LN
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2204
Mailing Address - Country:US
Mailing Address - Phone:304-788-3828
Mailing Address - Fax:
Practice Address - Street 1:22 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:WV
Practice Address - Zip Code:26750-1036
Practice Address - Country:US
Practice Address - Phone:304-355-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist