Healthcare Provider Details

I. General information

NPI: 1952375883
Provider Name (Legal Business Name): MATTHEW RICHARD RUTLEDGE RPH, BCOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICK RUTLEDGE

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 FITZSIMMONS DRIVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

7902 64TH STREET CT W
UNIVERSITY PLACE WA
98467-3906
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3123
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3123
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: