Provider Demographics
NPI:1073140307
Name:KHANNA, RUCHI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RUCHI
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 THORNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-2616
Mailing Address - Country:US
Mailing Address - Phone:914-419-4558
Mailing Address - Fax:
Practice Address - Street 1:780 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3832
Practice Address - Country:US
Practice Address - Phone:203-353-9117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052406183500000X
CTPCT.0010903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist