Basic Information
| Provider Information | |||||||||
| NPI: | 1083695811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSCIN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 WILLIAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627042805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177533895 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 701 N. FIRST STREET | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627949636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175453934 | ||||||||
| FaxNumber: | 2175457127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 14645 | CO | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | 051039436 | IL | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.