Provider Demographics
NPI:1427001072
Name:RUIZ RIVERA, LYDIA GINNETTE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:GINNETTE
Last Name:RUIZ RIVERA
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 1:1756 TINSMITH CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3369
Mailing Address - Country:US
Mailing Address - Phone:813-948-7717
Mailing Address - Fax:
Practice Address - Street 1:9912 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-3419
Practice Address - Country:US
Practice Address - Phone:727-869-4100
Practice Address - Fax:727-869-4255
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist