Provider Demographics
NPI:1952316564
Name:RUFFNER PHARMACY LLC
Entity Type:Organization
Organization Name:RUFFNER PHARMACY LLC
Other - Org Name:RUFFNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-296-6900
Mailing Address - Street 1:506 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2059
Mailing Address - Country:US
Mailing Address - Phone:402-296-6900
Mailing Address - Fax:402-296-6990
Practice Address - Street 1:506 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2059
Practice Address - Country:US
Practice Address - Phone:402-296-6900
Practice Address - Fax:402-296-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2592333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025039800Medicaid
2816657OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5010390001Medicare ID - Type Unspecified