Provider Demographics
NPI:1629769039
Name:RUGGIERO, LUCILLE
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5613
Mailing Address - Country:US
Mailing Address - Phone:917-807-3032
Mailing Address - Fax:
Practice Address - Street 1:4368 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3820
Practice Address - Country:US
Practice Address - Phone:718-227-3049
Practice Address - Fax:718-227-3056
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician