Provider Demographics
NPI:1487834594
Name:DAZ, RUTH A (RPH)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:DAZ
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 1:3863 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1309
Mailing Address - Country:US
Mailing Address - Phone:315-622-6020
Mailing Address - Fax:
Practice Address - Street 1:3863 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1309
Practice Address - Country:US
Practice Address - Phone:315-622-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist