Provider Demographics
NPI:1093228140
Name:RUCK, KIRSTIN M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:M
Last Name:RUCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2733
Mailing Address - Country:US
Mailing Address - Phone:860-436-9022
Mailing Address - Fax:
Practice Address - Street 1:80 TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1249
Practice Address - Country:US
Practice Address - Phone:860-563-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-12
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist