Basic Information
Provider Information | |||||||||
NPI: | 1649558115 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RUZICKA | ||||||||
FirstName: | APRIL | ||||||||
MiddleName: | F | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARMD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BERRY | ||||||||
OtherFirstName: | APRIL | ||||||||
OtherMiddleName: | F | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHARMD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4101 S 4TH ST | ||||||||
Address2: | PHARMACY SERVICE-119 | ||||||||
City: | LEAVENWORTH | ||||||||
State: | KS | ||||||||
PostalCode: | 660485014 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9136822000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4101 S 4TH ST | ||||||||
Address2: | PHARMACY SERVICE-119 | ||||||||
City: | LEAVENWORTH | ||||||||
State: | KS | ||||||||
PostalCode: | 660485014 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9136822000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2011 | ||||||||
LastUpdateDate: | 06/04/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1-14445 | KS | N |   | Pharmacy Service Providers | Pharmacist |   | 1835P1200X | 1-14445 | KS | N |   | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P0018X | 1-14445 | KS | Y |   | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.