Provider Demographics
NPI:1477975308
Name:RUBY, JEANINE (RPH)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:RUBY
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 1:716 W YELLOW WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-6654
Mailing Address - Country:US
Mailing Address - Phone:480-489-5530
Mailing Address - Fax:
Practice Address - Street 1:716 W YELLOW WOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-6654
Practice Address - Country:US
Practice Address - Phone:480-489-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist