MEDICARE: KRISTIN SHIREE RUDDY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	72715	CA

General Provider Information

NPI Number	:	1013420777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN SHIREE RUDDY PHARMD

Provider Business Mailing Address
First Line	:	1311 E FLORIDA AVE
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92544-8606
Country	:	US
Telephone Number	:	951-652-5776
Fax Number	:	951-652-7476

Provider Business Practice Location Address
First Line	:	1311 E FLORIDA AVE
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92544-8606
Country	:	US
Telephone Number	:	951-652-5776
Fax Number	:	951-652-7476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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