Provider Demographics
NPI:1184058430
Name:RUDD, ANNE CISAR
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:CISAR
Last Name:RUDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 SOUTHRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6608
Mailing Address - Country:US
Mailing Address - Phone:847-800-7833
Mailing Address - Fax:
Practice Address - Street 1:500 W CHRYSLER DR
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-6034
Practice Address - Country:US
Practice Address - Phone:815-544-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist