Active NPI
Mark Rudka, PHARMD
- Pharmacist
- Cicero, NY
National Provider Identifier
1407570583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 068007
- Practice address
- 8061 Brewerton Rd
Cicero, NY 13039-9585 - Phone
- (315) 698-2381
- NPI assigned
- Oct 3, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 068007 | NY | Primary |
Addresses
Primary practice location
8061 Brewerton Rd
Cicero, NY 13039-9585
Mailing address
366 Village Blvd N
Baldwinsville, NY 13027-3013
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
| License | State | Type | Specialty |
|---|---|---|---|
| 068007 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664755200000",
"number": "1407570583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "366 VILLAGE BLVD N",
"city": "BALDWINSVILLE",
"state": "NY",
"postal_code": "130273013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8061 BREWERTON RD",
"city": "CICERO",
"state": "NY",
"postal_code": "130399585",
"telephone_number": "315-698-2381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDKA",
"first_name": "MARK",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-03",
"last_updated": "2022-10-03",
"certification_date": "2022-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "068007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cicero, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.