Individual provider Active NPI

Whitney A Ruddock, PHARMD

  • Pharmacist
  • Port St Lucie, FL
National Provider Identifier
1053752600
Registry record updated Nov 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS53972 Issued in FL
Practice address
1936 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5509
Phone
(772) 446-9284
NPI assigned
Jul 11, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS53972 FL Primary

Addresses

Primary practice location

1936 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5509

Mailing address

2858 NW 95TH Ave
Coral Springs, FL 33065-5050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
PS53972FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Pain of the Palm Beaches PLLC CurrentSince Nov 17, 2019 Accepting new patients
Azof Enterprises Inc PastSince Nov 17, 2019 Accepting new patients

Locations

1936 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 446-9284

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1053752600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2858 NW 95TH AVE",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330655050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525509",
            "telephone_number": "772-446-9284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDOCK",
        "first_name": "WHITNEY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-11",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS53972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.