Provider Demographics
NPI:1700063815
Name:RULAND, MARCIA S (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:S
Last Name:RULAND
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 1:1904 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4022
Mailing Address - Country:US
Mailing Address - Phone:518-393-4589
Mailing Address - Fax:
Practice Address - Street 1:1409 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-2904
Practice Address - Country:US
Practice Address - Phone:518-355-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00528836Medicaid