Provider Demographics
NPI:1265794721
Name:SEYEDROUDBARI, JUDY M (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:M
Last Name:SEYEDROUDBARI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:CREAMERY
Mailing Address - State:PA
Mailing Address - Zip Code:19430-0095
Mailing Address - Country:US
Mailing Address - Phone:484-753-1900
Mailing Address - Fax:
Practice Address - Street 1:4000 LANDIS RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1136
Practice Address - Country:US
Practice Address - Phone:484-753-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist