MEDICARE: NICOLE MARIE RIVERA RULLAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03445044	OH

General Provider Information

NPI Number	:	1184577140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE RIVERA RULLAN PHARMD

Provider Business Mailing Address
First Line	:	60 N STYGLER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-2435
Country	:	US
Telephone Number	:	614-475-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 N STYGLER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-2435
Country	:	US
Telephone Number	:	614-475-2014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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