Healthcare Provider Details

I. General information

NPI: 1326101403
Provider Name (Legal Business Name): PHILIP WALTER RUARK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 NORWICH AVE
FRANKLIN FURNACE OH
45629-8892
US

IV. Provider business mailing address

115 SCOTT AVE
FRANKLIN FURNACE OH
45629-8905
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-9983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-19006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: