MEDICARE: MR. RUDY DAJIE 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	10734	CT

General Provider Information

NPI Number	:	1972808087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUDY DAJIE PHARM D

Provider Business Mailing Address
First Line	:	342 N MAIN ST STE 70
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-2500
Country	:	US
Telephone Number	:	860-236-3564
Fax Number	:	860-882-1791

Provider Business Practice Location Address
First Line	:	342 N MAIN ST STE 70
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-2500
Country	:	US
Telephone Number	:	860-236-3564
Fax Number	:	860-882-1791

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

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	01/20/2011

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