Provider Demographics
NPI:1316119803
Name:RUDOLPH, DENNIS WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:WAYNE
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 GOLD DUST CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-2056
Mailing Address - Country:US
Mailing Address - Phone:406-248-6883
Mailing Address - Fax:
Practice Address - Street 1:960 GOLD DUST CIR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-2056
Practice Address - Country:US
Practice Address - Phone:406-248-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist