Healthcare Provider Details

I. General information

NPI: 1194095703
Provider Name (Legal Business Name): MICHAEL WILLIAM RULLI PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 DOUGLAS AVE
DES MOINES IA
50310-2717
US

IV. Provider business mailing address

4415 DOUGLAS AVE
DES MOINES IA
50310-2717
US

V. Phone/Fax

Practice location:
  • Phone: 515-279-4739
  • Fax: 515-279-0254
Mailing address:
  • Phone: 515-279-4739
  • Fax: 515-279-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19739
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: