Provider Demographics
NPI:1386356525
Name:RUCKMAN, MICHELLE LYNN (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:RUCKMAN
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 1:4150 TULLER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-5014
Mailing Address - Country:US
Mailing Address - Phone:888-761-2077
Mailing Address - Fax:
Practice Address - Street 1:4150 TULLER RD STE 230
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5014
Practice Address - Country:US
Practice Address - Phone:888-761-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3122498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist