Provider Demographics
NPI:1942499058
Name:RUDOLPH, MICHAEL JAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15141 WHITTIER BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2160
Mailing Address - Country:US
Mailing Address - Phone:562-693-3791
Mailing Address - Fax:562-945-9540
Practice Address - Street 1:15141 WHITTIER BLVD STE 115
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2160
Practice Address - Country:US
Practice Address - Phone:562-693-3791
Practice Address - Fax:562-945-9540
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA30245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist