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General NPI Number Information
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NPI Number | 1780682799
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Entity Type | Individual
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Provider Name | PAULL JOSEPH RUKAVINA RPH.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 2270 FORD PKWY
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City | SAINT PAUL
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State | MN
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Zip | 55116-3337
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Country | US
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Telephone | 651-696-5000
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Fax | 651-696-5066
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Provider Business Mailing Address
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Address Line | 3345 SHERMAN CT APT 414
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City | EAGAN
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State | MN
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Zip | 55121-5022
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Country | US
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Telephone | 651-894-2355
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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 | 114552-4
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 114552
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License Number State | MN
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