MEDICARE: RUDI PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP415530L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3984223	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518936491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUDI PHARMACY INC

Provider Business Mailing Address
First Line	:	2401 PENNSYLVANIA AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3010
Country	:	US
Telephone Number	:	215-232-0533
Fax Number	:	215-232-1927

Provider Business Practice Location Address
First Line	:	2401 PENNSYLVANIA AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3010
Country	:	US
Telephone Number	:	215-232-0533
Fax Number	:	215-232-1927

Authorized Official
Title or Position	:	OWNER MANAGER
Name	:	JOSEPH RUDOLPH
Credential	:	PHARMACIST
Telephone Number	:	215-232-0533

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/11/2011

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Directions to “RUDI PHARMACY INC ” Practice Location

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