Provider Demographics
NPI:1518092105
Name:RUIZ, JOSEPHINE (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:RUIZ
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:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1881
Mailing Address - Country:US
Mailing Address - Phone:787-891-9281
Mailing Address - Fax:787-891-3054
Practice Address - Street 1:492 AVE VICTORIA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4729
Practice Address - Country:US
Practice Address - Phone:787-891-9281
Practice Address - Fax:787-891-3054
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3676183500000X
PR4179283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5549110001Medicare NSC