Healthcare Provider Details

I. General information

NPI: 1982050928
Provider Name (Legal Business Name): JOHN RUDDER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7022 N MESA ST
EL PASO TX
79912-3649
US

IV. Provider business mailing address

7022 N MESA ST
EL PASO TX
79912-3649
US

V. Phone/Fax

Practice location:
  • Phone: 915-584-9481
  • Fax: 915-587-4306
Mailing address:
  • Phone: 915-584-9481
  • Fax: 915-587-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number14871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: