Provider Demographics
NPI:1326242850
Name:RUFFNER PHARMACY, LLC
Entity Type:Organization
Organization Name:RUFFNER PHARMACY, LLC
Other - Org Name:RUFFNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-527-4006
Mailing Address - Street 1:409 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1826
Mailing Address - Country:US
Mailing Address - Phone:712-527-4006
Mailing Address - Fax:712-527-4113
Practice Address - Street 1:409 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1826
Practice Address - Country:US
Practice Address - Phone:712-527-4006
Practice Address - Fax:712-527-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0786509Medicaid
5010390002Medicare NSC