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General NPI Number Information
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NPI Number | 1245649987
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Entity Type | Individual
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Provider Name | LARRY RUTEBUKA PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 25755 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-3812
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Country | US
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Telephone | 909-283-7261
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Fax | 909-283-7240
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Provider Business Mailing Address
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Address Line | 25755 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-3812
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Country | US
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Telephone | 909-283-7261
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Fax | 909-283-7240
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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 | 65192
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License Number State | CA
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