Provider Demographics
NPI:1962542886
Name:RUANE, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RUANE
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 1:310 ADAMS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1620
Mailing Address - Country:US
Mailing Address - Phone:570-207-6860
Mailing Address - Fax:570-207-6368
Practice Address - Street 1:310 ADAMS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1620
Practice Address - Country:US
Practice Address - Phone:570-207-6860
Practice Address - Fax:570-207-6368
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018760990001Medicaid
PA4315330001Medicare ID - Type UnspecifiedPROVIDER ID #