Provider Demographics
NPI:1487293478
Name:RUDOLPH, TANYA SUE (RPH)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:SUE
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:SUE
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:112 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201
Mailing Address - Country:US
Mailing Address - Phone:717-267-7195
Mailing Address - Fax:717-267-7727
Practice Address - Street 1:112 N 7TH STREET
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-267-7195
Practice Address - Fax:717-267-7727
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist