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General NPI Number Information
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NPI Number | 1356816524
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Entity Type | Individual
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Provider Name | SYRA RUHL
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Gender | Female
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 1030 W 21ST ST
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City | SOUTH SIOUX CITY
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State | NE
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Zip | 68776-2661
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Country | US
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Telephone | 402-494-8927
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Fax |
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Provider Business Mailing Address
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Address Line | 7811 S 101ST ST
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City | LA VISTA
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State | NE
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Zip | 68128-8239
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Country | US
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Telephone | 402-281-5628
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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 | 6605
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License Number State | SD
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