Healthcare Provider Details

I. General information

NPI: 1073046892
Provider Name (Legal Business Name): RUTA GEBREGIORGIS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W JOHN CARPENTER FWY
IRVING TX
75039-2500
US

IV. Provider business mailing address

750 W JOHN CARPENTER FWY
IRVING TX
75039-2500
US

V. Phone/Fax

Practice location:
  • Phone: 972-492-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: