Provider Demographics
NPI:1073046892
Name:GEBREGIORGIS, RUTA (PHARM D)
Entity Type:Individual
Prefix:
First Name:RUTA
Middle Name:
Last Name:GEBREGIORGIS
Suffix:
Gender:F
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 1:3035 RENAISSANCE CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5944
Mailing Address - Country:US
Mailing Address - Phone:469-328-5054
Mailing Address - Fax:
Practice Address - Street 1:3035 RENAISSANCE CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5944
Practice Address - Country:US
Practice Address - Phone:469-328-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist