1164724779 NPI number — CMA MEDS, INC

Table of content: MRS. LORI ANN RUDKER RPH (NPI 1912417718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164724779 NPI number — CMA MEDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMA MEDS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHEN MED RX AVENTURA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164724779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 PARK CENTRE BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33169-5373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-621-0023
Provider Business Mailing Address Fax Number:
305-623-9188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 AVENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-466-7333
Provider Business Practice Location Address Fax Number:
305-466-7363
Provider Enumeration Date:
12/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-621-0023

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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