Provider Demographics
NPI:1801182381
Name:RUDYI, MELISSA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:RUDYI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6560 S FEDERAL WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9277
Mailing Address - Country:US
Mailing Address - Phone:208-429-1088
Mailing Address - Fax:208-429-1090
Practice Address - Street 1:6560 S FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-9277
Practice Address - Country:US
Practice Address - Phone:208-429-1088
Practice Address - Fax:208-429-1090
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist