NPIMap

Individual provider Active NPI

Deborah H Rudolf, RPH

  • Pharmacist
  • East Windsor, CT
National Provider Identifier
1225548969
Registry record updated Oct 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
6093 Issued in CT
Practice address
67 Prospect Hill Rd
East Windsor, CT 06088-3605
Phone
(860) 623-1407
NPI assigned
Oct 9, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2017

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0015998 OR
Pharmacist 183500000X 60758350 WA
Pharmacist 183500000X P7808 ID
Pharmacist 183500000X 6093 CT Primary

Addresses

Primary practice location

67 Prospect Hill Rd
East Windsor, CT 06088-3605

Mailing address

67 Prospect Hill Rd
East Windsor, CT 06088-3605
Phone (860) 623-1407

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
P7808IDMDPharmacist
0015998ORMDPharmacist
60758350WAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Big Y Foods Inc Past Accepting new patients
Big Y Foods, Inc Past Accepting new patients

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": "1507507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507507200000",
    "number": "1225548969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 PROSPECT HILL RD",
            "city": "EAST WINDSOR",
            "state": "CT",
            "postal_code": "060883605",
            "telephone_number": "860-623-1407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 PROSPECT HILL RD",
            "city": "EAST WINDSOR",
            "state": "CT",
            "postal_code": "060883605",
            "telephone_number": "860-623-1407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLF",
        "first_name": "DEBORAH",
        "middle_name": "H",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-09",
        "last_updated": "2017-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "0015998",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "60758350",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P7808",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "6093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; 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.