MEDICARE: NICOLE RUSZKOWSKI 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	63105	TX

General Provider Information

NPI Number	:	1447881065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RUSZKOWSKI PHARMD

Provider Business Mailing Address
First Line	:	4901 MAPLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-8210
Country	:	US
Telephone Number	:	972-725-1270
Fax Number	:	972-725-1272

Provider Business Practice Location Address
First Line	:	4901 MAPLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-8210
Country	:	US
Telephone Number	:	972-725-1270
Fax Number	:	972-725-1272

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

Provider Enumeration Date	:	02/01/2020
Last Update Date	:	05/11/2026

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