Provider Demographics
NPI:1508140104
Name:RUIZ, KRISTY LINN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LINN
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 POSSUM PASS CT
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-9467
Mailing Address - Country:US
Mailing Address - Phone:217-652-8582
Mailing Address - Fax:
Practice Address - Street 1:2322 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5545
Practice Address - Country:US
Practice Address - Phone:217-652-8582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-01
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-295096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist