Provider Demographics
NPI:1558132985
Name:RUBYS PHARMACY INC
Entity Type:Organization
Organization Name:RUBYS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:240-527-5556
Mailing Address - Street 1:509 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAXTON
Mailing Address - State:PA
Mailing Address - Zip Code:16678-1050
Mailing Address - Country:US
Mailing Address - Phone:814-635-7488
Mailing Address - Fax:814-635-7447
Practice Address - Street 1:509 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SAXTON
Practice Address - State:PA
Practice Address - Zip Code:16678-1050
Practice Address - Country:US
Practice Address - Phone:814-635-7488
Practice Address - Fax:814-635-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103648676-0001Medicaid