Healthcare Provider Details

I. General information

NPI: 1023265923
Provider Name (Legal Business Name): TAMMIE M RUZYCKI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W MAIN ST
GOWANDA NY
14070-1305
US

IV. Provider business mailing address

31 W MAIN ST
GOWANDA NY
14070-1305
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-1700
  • Fax: 716-532-1808
Mailing address:
  • Phone: 716-532-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048722
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: