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General NPI Number Information
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NPI Number | 1629316047
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Entity Type | Organization
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Legal Business Name | RUTMEL, INC
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 3736 MIKE PADGETT HWY
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City | AUGUSTA
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State | GA
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Zip | 30906-0719
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Country | US
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Telephone | 706-262-4455
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Fax | 706-262-4455
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | GRACEWOOD
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State | GA
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Zip | 30812-0005
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Country | US
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Telephone | 706-262-4455
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Fax | 706-262-4455
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Authorized Official
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Title or Position | R.PH., CHIEF OPERATING OFFICER
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Name | VICTOR L JOHNSON
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Credential |
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Telephone | 706-262-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE009894
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License Number State | GA
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