Stephen Rudawski, BSPHARM
Individual provider Active NPI Pharmacist · Fox Lake, IL
NPI 1972909059 · NPPES record last updated Nov 17, 2014
Key facts
- NPI
- 1972909059
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051031771 (IL)
- Practice address
- 161 S US Highway 12
Fox Lake, IL 60020-1796 - Phone
- (847) 587-0505
- Fax
- (847) 587-2633
- NPI assigned
- Nov 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051031771 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051031771 | IL | Yes |
| Pharmacotherapy Pharmacist | 1835P1200X | 051031771 | IL |
Addresses
Primary practice location
161 S US Highway 12
Fox Lake, IL 60020-1796
Mailing address
161 S US Highway 12
Fox Lake, IL 60020-1796
Phone (847) 587-0505
Other providers in Fox Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.