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NPI Code Detail

MEDICARE: MR. GREGORY JOSEPH RUDROFF RPH

MEDICARE: MR. GREGORY JOSEPH RUDROFF RPH
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
1183500000XPharmacist042230MO

General Provider Information

NPI Number : 1134404791
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY JOSEPH RUDROFF RPH
Provider Business Mailing Address
First Line : 336 6TH ST
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-2322
Country : US
Telephone Number : 573-756-7861
Fax Number :
Provider Business Practice Location Address
First Line : 600 W KARSCH BLVD
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-3342
Country : US
Telephone Number : 573-756-7861
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2011
Last Update Date : 10/14/2011

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