MEDICARE: DR. CARLY RUDICK PHARM D.

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
1	183500000X	Pharmacist	RP438586	PA

General Provider Information

NPI Number	:	1376876037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLY RUDICK PHARM D.

Provider Business Mailing Address
First Line	:	8931 ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-2704
Country	:	US
Telephone Number	:	724-863-5398
Fax Number	:	724-863-5398

Provider Business Practice Location Address
First Line	:	8931 ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-2704
Country	:	US
Telephone Number	:	724-863-5398
Fax Number	:	724-863-5398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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