Provider Demographics
NPI:1588871008
Name:RUDE, DOUGLAS HAROLD (RPH)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:HAROLD
Last Name:RUDE
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 1:6271 LAMPKINS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37046-9151
Mailing Address - Country:US
Mailing Address - Phone:615-477-7880
Mailing Address - Fax:615-395-4847
Practice Address - Street 1:WALGREENS PHARMACY
Practice Address - Street 2:9100 CAROTHERS PARKWAY
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064
Practice Address - Country:US
Practice Address - Phone:615-771-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000015343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist