=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598848533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J RUTOWSKI OF ELMA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 09/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2317 BOWEN RD
-----------------------------------------------------
City | ELMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14059-9497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-652-3920
-----------------------------------------------------
Fax | 716-652-3010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 90 2317 BOWEN RD
-----------------------------------------------------
City | ELMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14059-0090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-652-3920
-----------------------------------------------------
Fax | 716-652-3010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | JOHN RUTOWSKI
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 716-652-3920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 028512
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------