1124497672 NPI number — DR. SAMANTHA JEAN RUCKMAN PHARMD

Table of content: DR. SAMANTHA JEAN RUCKMAN PHARMD (NPI 1124497672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124497672 NPI number — DR. SAMANTHA JEAN RUCKMAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUCKMAN
Provider First Name:
SAMANTHA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUSH
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124497672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3579 E 1/2 ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALISADE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81526-9562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-518-3028
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2770 US HIGHWAY 50
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81503-2294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-245-1215
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0021009 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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