Provider Demographics
NPI:1629157391
Name:RUKE PHARMACY INC.
Entity Type:Organization
Organization Name:RUKE PHARMACY INC.
Other - Org Name:RUKES DISCOUNT PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-262-5590
Mailing Address - Street 1:108 S ROCK ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2733
Mailing Address - Country:US
Mailing Address - Phone:405-262-5590
Mailing Address - Fax:405-262-5593
Practice Address - Street 1:108 S ROCK ISLAND AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2733
Practice Address - Country:US
Practice Address - Phone:405-262-5590
Practice Address - Fax:405-262-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2645053336C0003X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072526OtherPK
OK100232540AMedicaid