Healthcare Provider Details

I. General information

NPI: 1720300858
Provider Name (Legal Business Name): DARLENE RUZICKA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LAKEVIEW AVE
LYNBROOK NY
11563-1742
US

IV. Provider business mailing address

133 LAKEVIEW AVE
LYNBROOK NY
11563-1742
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-4646
  • Fax: 516-599-6383
Mailing address:
  • Phone: 516-599-4646
  • Fax: 516-599-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049950
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number014809
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD11191
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: