Healthcare Provider Details

I. General information

NPI: 1962784017
Provider Name (Legal Business Name): RUTH JI DEDE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

V. Phone/Fax

Practice location:
  • Phone: 619-370-2856
  • Fax:
Mailing address:
  • Phone: 619-370-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65529
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03233171
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22498
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: