Provider Demographics
NPI:1124140421
Name:RUIZ, RAUL R (RPH)
Entity type:Individual
Prefix:MR
First Name:RAUL
Middle Name:R
Last Name:RUIZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:07093-3716
Mailing Address - Country:US
Mailing Address - Phone:201-868-5005
Mailing Address - Fax:201-868-5974
Practice Address - Street 1:6000 PARK AVE
Practice Address - Street 2:GILMORE PHARMACY
Practice Address - City:WEST NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:07093-3716
Practice Address - Country:US
Practice Address - Phone:201-868-5005
Practice Address - Fax:201-868-5974
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist