Provider Demographics
NPI:1801135215
Name:RUANE, NICOLE H (RPH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:H
Last Name:RUANE
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 1:706 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-1426
Mailing Address - Country:US
Mailing Address - Phone:610-304-9268
Mailing Address - Fax:
Practice Address - Street 1:1001 13TH ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3254
Practice Address - Country:US
Practice Address - Phone:218-741-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121154183500000X
PARP036128L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist