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General NPI Number Information
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NPI Number | 1053802314
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Entity Type | Individual
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Provider Name | LIDIJA RUSKOVA RPH
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Gender | Female
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 244 FOREST AVE
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2114
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Country | US
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Telephone | 949-494-1059
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Fax |
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Provider Business Mailing Address
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Address Line | 3362 WATERMARKE PL
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City | IRVINE
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State | CA
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Zip | 92612-5618
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Country | US
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Telephone | 949-378-6335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 73682
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License Number State | CA
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