Provider Demographics
NPI:1851620843
Name:RUBY PLAZA INC
Entity Type:Organization
Organization Name:RUBY PLAZA INC
Other - Org Name:RUBY HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJIB
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-394-5700
Mailing Address - Street 1:5020 WINTERS CHAPEL RD STE B
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1735
Mailing Address - Country:US
Mailing Address - Phone:770-394-5700
Mailing Address - Fax:770-394-5772
Practice Address - Street 1:5020 WINTERS CHAPEL RD STE B
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30360-1735
Practice Address - Country:US
Practice Address - Phone:770-394-5700
Practice Address - Fax:770-394-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0096223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1159462OtherNCPDP PROVIDER IDENTIFICATION NUMBER