Provider Demographics
NPI:1184914905
Name:RUENHORST, EILEEN MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:MARIE
Last Name:RUENHORST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1863
Mailing Address - Country:US
Mailing Address - Phone:203-926-1970
Mailing Address - Fax:
Practice Address - Street 1:508 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2309
Practice Address - Country:US
Practice Address - Phone:203-268-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist