Healthcare Provider Details

I. General information

NPI: 1619529807
Provider Name (Legal Business Name): BEATA MARIA RUCINSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MAPLE ST
DANVERS MA
01923-4065
US

IV. Provider business mailing address

480 MAPLE ST
DANVERS MA
01923-4065
US

V. Phone/Fax

Practice location:
  • Phone: 978-304-8458
  • Fax: 978-304-8447
Mailing address:
  • Phone: 978-304-8458
  • Fax: 978-304-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH26136
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: