Provider Demographics
NPI:1730856386
Name:RUCKS, CASSANDRA SUE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:SUE
Last Name:RUCKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1038 APACHE AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-8551
Mailing Address - Country:US
Mailing Address - Phone:920-858-2168
Mailing Address - Fax:
Practice Address - Street 1:981 N SHAWANO ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9380
Practice Address - Country:US
Practice Address - Phone:920-982-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20824-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist