Healthcare Provider Details

I. General information

NPI: 1497611214
Provider Name (Legal Business Name): RUDD HETRICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 W 151ST ST
OLATHE KS
66061-5350
US

IV. Provider business mailing address

5912 W 101ST TER
OVERLAND PARK KS
66207-3052
US

V. Phone/Fax

Practice location:
  • Phone: 913-445-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number1-14525
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: