MEDICARE: PAULL JOSEPH RUKAVINA RPH.

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	114552-4	MN
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	114552	MN

General Provider Information

NPI Number	:	1780682799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULL JOSEPH RUKAVINA RPH.

Provider Business Mailing Address
First Line	:	3345 SHERMAN CT APT 414
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-5022
Country	:	US
Telephone Number	:	651-894-2355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 FORD PKWY
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3337
Country	:	US
Telephone Number	:	651-696-5000
Fax Number	:	651-696-5066

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/21/2025

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