Provider Demographics
NPI:1942089461
Name:RUGGLES, SHELBY ARLINE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ARLINE
Last Name:RUGGLES
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 1:3208 COLCORD AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-1814
Mailing Address - Country:US
Mailing Address - Phone:254-400-6903
Mailing Address - Fax:
Practice Address - Street 1:11675 FM 2154 RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4737
Practice Address - Country:US
Practice Address - Phone:979-485-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42755183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician