Basic Information
| Provider Information | |||||||||
| NPI: | 1902892144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUCKI | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPH CCP CGP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661142 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 136 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325749015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 07/06/2011 | ||||||||
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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 | 183500000X | 28RI02097400 | NJ | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 049525 | NY | N | Pharmacy Service Providers | Pharmacist |
No ID Information.