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General NPI Number Information
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NPI Number | 1720098122
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Entity Type | Organization
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Legal Business Name | RUSHVILLE PHARMACY, INC.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 302 N MAIN ST
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City | RUSHVILLE
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State | IN
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Zip | 46173-1636
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Country | US
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Telephone | 765-932-3328
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Fax | 765-932-3824
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Provider Business Mailing Address
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Address Line | 302 N MAIN ST
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City | RUSHVILLE
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State | IN
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Zip | 46173-1636
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Country | US
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Telephone | 765-932-3328
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Fax | 765-932-3824
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | MR. KIPLAND JAY BURKETT
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Credential |
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Telephone | 765-932-3328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60001488A
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License Number State | IN
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