Provider Demographics
NPI:1972855070
Name:RUIZ, MORAIMA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MORAIMA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 AVE.ISLA VERDE
Mailing Address - Street 2:COND.LOS PINOS TORRE OESTE APT.2H
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-385-2660
Mailing Address - Fax:
Practice Address - Street 1:6400 AVE.ISLA VERDE
Practice Address - Street 2:COND.LOS PINOS TORRE OESTE APT.2H
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-385-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3922OtherPHARMACIST