Provider Demographics
NPI:1376671636
Name:JOSEPH C RUSKIN ENTERPRISES INC
Entity Type:Organization
Organization Name:JOSEPH C RUSKIN ENTERPRISES INC
Other - Org Name:PIKES PEAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TREAT
Authorized Official - Suffix:
Authorized Official - Credentials:INTERN
Authorized Official - Phone:719-447-9900
Mailing Address - Street 1:2504 E PIKES PEAK AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-7039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2504 E PIKES PEAK AVE STE 106
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-7039
Practice Address - Country:US
Practice Address - Phone:719-447-9900
Practice Address - Fax:719-447-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO6123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0619506OtherOTHER ID NUMBER
0619506OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CO69457212Medicaid