Healthcare Provider Details

I. General information

NPI: 1033425384
Provider Name (Legal Business Name): TAMARA RUGGLES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 GRANITE DR
BISMARCK ND
58503-6133
US

IV. Provider business mailing address

4730 GRANITE DR
BISMARCK ND
58503-6133
US

V. Phone/Fax

Practice location:
  • Phone: 701-343-1970
  • Fax:
Mailing address:
  • Phone: 701-220-8798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5317
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: