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General NPI Number Information
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NPI Number | 1649633025
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Entity Type | Individual
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Provider Name | JERRY RULON
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Gender | Male
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 1050 NW 38TH ST
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City | LAWTON
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State | OK
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Zip | 73505-3704
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Country | US
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Telephone | 580-355-7124
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Fax | 847-396-2515
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Provider Business Mailing Address
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Address Line | 1004 WAVERLY WAY
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City | ELGIN
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State | OK
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Zip | 73538-3834
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Country | US
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Telephone | 580-591-2520
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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 | 11277
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License Number State | OK
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