Healthcare Provider Details

I. General information

NPI: 1831567619
Provider Name (Legal Business Name): LAUREN RUGE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ELK GROVE TOWN CTR
ELK GROVE VILLAGE IL
60007-3754
US

IV. Provider business mailing address

930 ELK GROVE TOWN CTR
ELK GROVE VILLAGE IL
60007-3754
US

V. Phone/Fax

Practice location:
  • Phone: 847-439-4710
  • Fax: 847-640-1109
Mailing address:
  • Phone: 847-668-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051298751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: