Provider Demographics
NPI:1598924557
Name:RUKAVENA, JOHN PETER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:RUKAVENA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 E BASELINE RD
Mailing Address - Street 2:A109255
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9221 E BASELINE RD
Practice Address - Street 2:A109255
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-8310
Practice Address - Country:US
Practice Address - Phone:315-542-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist