Provider Demographics
NPI:1083225171
Name:RULLO, RACQUEL LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RACQUEL
Middle Name:LEE
Last Name:RULLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 E LONG ST APT 118
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3316
Mailing Address - Country:US
Mailing Address - Phone:330-998-3304
Mailing Address - Fax:
Practice Address - Street 1:6201 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5500
Practice Address - Country:US
Practice Address - Phone:614-367-7526
Practice Address - Fax:614-367-7565
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033380801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist