Healthcare Provider Details

I. General information

NPI: 1487378568
Provider Name (Legal Business Name): JANICE RUAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BROADWAY
AMITYVILLE NY
11701-2708
US

IV. Provider business mailing address

275 BROADWAY
AMITYVILLE NY
11701-2708
US

V. Phone/Fax

Practice location:
  • Phone: 631-841-1630
  • Fax:
Mailing address:
  • Phone: 631-841-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: