Provider Demographics
NPI:1972808087
Name:DAJIE, RUDY (PHARM D)
Entity type:Individual
Prefix:MR
First Name:RUDY
Middle Name:
Last Name:DAJIE
Suffix:
Gender:M
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 1:342 N MAIN ST STE 70
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2500
Mailing Address - Country:US
Mailing Address - Phone:860-236-3564
Mailing Address - Fax:860-882-1791
Practice Address - Street 1:342 N MAIN ST STE 70
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2500
Practice Address - Country:US
Practice Address - Phone:860-236-3564
Practice Address - Fax:860-882-1791
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist