Provider Demographics
NPI:1437465010
Name:RUBY, JENNIFER JANSEN (RPH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JANSEN
Last Name:RUBY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2800 EAST WHITESTONE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-528-0150
Mailing Address - Fax:512-528-0400
Practice Address - Street 1:2800 EAST WHITESTONE BOULEVARD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-528-0150
Practice Address - Fax:512-528-0400
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist