=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538416334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOMINICK RUTHERFORD PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2012
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34841 VETERANS PLZ
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48184-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-728-8306
-----------------------------------------------------
Fax | 734-728-8065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7123 MISSION HILLS DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-9555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-417-0637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302038877
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------