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General NPI Number Information
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NPI Number | 1508841222
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Entity Type | Individual
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Provider Name | KELLY M RUDD PHARM.D., BCPS
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1111 W 17TH ST
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City | TULSA
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State | OK
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Zip | 74107-1886
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Country | US
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Telephone | 185-618-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 34794 S HIGHWAY 82
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City | VINITA
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State | OK
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Zip | 74301-7045
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Country | US
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Telephone | 315-717-3268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19713
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 050193
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19454
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License Number State | OK
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