Provider Demographics
NPI:1881859031
Name:PUDHORODSKY, THEODORE GERARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:GERARD
Last Name:PUDHORODSKY
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 1:21 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2853
Mailing Address - Country:US
Mailing Address - Phone:716-667-3967
Mailing Address - Fax:
Practice Address - Street 1:21 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2853
Practice Address - Country:US
Practice Address - Phone:716-667-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist