Provider Demographics
NPI:1760992275
Name:RUDLOFF, CECILIA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:MARIE
Last Name:RUDLOFF
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 1:4400 EMILE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-0600
Mailing Address - Country:US
Mailing Address - Phone:402-390-0650
Mailing Address - Fax:
Practice Address - Street 1:4400 EMILE ST DURHAM OUTPATIENT CENTER LEVEL TWO
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-3301
Practice Address - Country:US
Practice Address - Phone:402-559-5215
Practice Address - Fax:402-559-7150
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA209591835P2201X, 183500000X, 1835P0018X
NE113661835P2201X, 183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist