Provider Demographics
NPI:1770868937
Name:RUUD, ANTHONY STAFFORD (PHARM-D)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:STAFFORD
Last Name:RUUD
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-1538
Mailing Address - Country:US
Mailing Address - Phone:208-847-0806
Mailing Address - Fax:208-847-0841
Practice Address - Street 1:130 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-1538
Practice Address - Country:US
Practice Address - Phone:208-847-0806
Practice Address - Fax:208-847-0841
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist