Provider Demographics
NPI:1932671377
Name:SU, RUTH (PHARMD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 N MALL WAY APT 332
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-5072
Mailing Address - Country:US
Mailing Address - Phone:615-294-6278
Mailing Address - Fax:
Practice Address - Street 1:6300 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2761
Practice Address - Country:US
Practice Address - Phone:928-863-7331
Practice Address - Fax:928-635-7140
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03338144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist