Healthcare Provider Details

I. General information

NPI: 1124616669
Provider Name (Legal Business Name): KAMIL RUDZINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AMERICAN ST
CATASAUQUA PA
18032-1800
US

IV. Provider business mailing address

300 AMERICAN ST
CATASAUQUA PA
18032-1800
US

V. Phone/Fax

Practice location:
  • Phone: 610-264-5471
  • Fax:
Mailing address:
  • Phone: 610-264-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449936
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: