Provider Demographics
NPI:1780700575
Name:RUEBENSAAL, NELLY J (RPH)
Entity type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:J
Last Name:RUEBENSAAL
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 1:38900 BIGGS RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9463
Mailing Address - Country:US
Mailing Address - Phone:440-926-2104
Mailing Address - Fax:
Practice Address - Street 1:479 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044
Practice Address - Country:US
Practice Address - Phone:440-926-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03310442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist