Provider Demographics
NPI:1497168439
Name:RUGGLES, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12922 W SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9509
Mailing Address - Country:US
Mailing Address - Phone:414-324-7724
Mailing Address - Fax:
Practice Address - Street 1:13870 W GREENWAY RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5293
Practice Address - Country:US
Practice Address - Phone:623-546-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist