Provider Demographics
NPI:1962686121
Name:RUFFRANO, MICHAEL NELSON (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NELSON
Last Name:RUFFRANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9390
Mailing Address - Country:US
Mailing Address - Phone:315-566-9404
Mailing Address - Fax:315-699-1571
Practice Address - Street 1:8379 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9390
Practice Address - Country:US
Practice Address - Phone:315-566-9404
Practice Address - Fax:315-699-1571
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01143113Medicaid