Healthcare Provider Details

I. General information

NPI: 1225102759
Provider Name (Legal Business Name): J RUTOWSKI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 CLEVELAND DR
CHEEKTOWAGA NY
14225-1221
US

IV. Provider business mailing address

1031 CLEVELAND DR
CHEEKTOWAGA NY
14225-1221
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-4888
  • Fax: 716-632-4488
Mailing address:
  • Phone: 716-632-4888
  • Fax: 716-632-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0016239
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOESPH RUTOWSKI
Title or Position: RPH
Credential: RPH
Phone: 716-632-6114