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General NPI Number Information
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NPI Number | 1386902567
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Entity Type | Individual
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Provider Name | DEBRA RUCKER
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Gender | Female
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 5050 STATE HIGHWAY 303 NE
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City | BREMERTON
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State | WA
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Zip | 98311-3629
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Country | US
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Telephone | 360-792-2833
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Fax | 360-792-2792
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Provider Business Mailing Address
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Address Line | 5050 STATE HIGHWAY 303 NE
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City | BREMERTON
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State | WA
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Zip | 98311-3629
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Country | US
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Telephone | 360-792-2833
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Fax | 360-792-2792
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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 | PH00010099
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License Number State | WA
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