Healthcare Provider Details

I. General information

NPI: 1962097584
Provider Name (Legal Business Name): BRENNA RUHNKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MILLBROOK PLZ
MILL HALL PA
17751-1911
US

IV. Provider business mailing address

68 CAROL LN
MALVERN PA
19355-2046
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-1130
  • Fax:
Mailing address:
  • Phone: 610-350-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberJ9R5H3D3
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: