Healthcare Provider Details

I. General information

NPI: 1710980503
Provider Name (Legal Business Name): GARY ROBERT RUTHERFORD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 W BROAD ST
COLUMBUS OH
43204-2643
US

IV. Provider business mailing address

4499 SUMMIT RIDGE RD
COLUMBUS OH
43220-2250
US

V. Phone/Fax

Practice location:
  • Phone: 614-351-0062
  • Fax: 614-351-0358
Mailing address:
  • Phone: 614-351-0062
  • Fax: 614-351-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03112410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: