Provider Demographics
NPI:1154149359
Name:RUIZ, BRIAN AXEL
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:AXEL
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5754 KYLE PKWY
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2404
Mailing Address - Country:US
Mailing Address - Phone:512-268-0412
Mailing Address - Fax:512-268-1791
Practice Address - Street 1:5754 KYLE PKWY
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2404
Practice Address - Country:US
Practice Address - Phone:512-268-0412
Practice Address - Fax:512-268-1791
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist