Provider Demographics
NPI:1124497672
Name:RUCKMAN, SAMANTHA JEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JEAN
Last Name:RUCKMAN
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JEAN
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3579 E 1/2 ROAD
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-9562
Mailing Address - Country:US
Mailing Address - Phone:303-518-3028
Mailing Address - Fax:
Practice Address - Street 1:2770 US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-2294
Practice Address - Country:US
Practice Address - Phone:970-245-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist