Provider Demographics
NPI:1245649987
Name:RUTEBUKA, LARRY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:RUTEBUKA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25755 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3812
Mailing Address - Country:US
Mailing Address - Phone:909-283-7261
Mailing Address - Fax:909-283-7240
Practice Address - Street 1:25755 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3812
Practice Address - Country:US
Practice Address - Phone:909-283-7261
Practice Address - Fax:909-283-7240
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist