MEDICARE: RUTMEL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHRE009894	GA

General Provider Information

NPI Number	:	1629316047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTMEL, INC

Provider Business Mailing Address
First Line	:	PO BOX 5
Second Line	:
City	:	GRACEWOOD
State	:	GA
Zip	:	30812-0005
Country	:	US
Telephone Number	:	706-262-4455
Fax Number	:	706-262-4455

Provider Business Practice Location Address
First Line	:	3736 MIKE PADGETT HWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-0719
Country	:	US
Telephone Number	:	706-262-4455
Fax Number	:	706-262-4455

Authorized Official
Title or Position	:	R.PH., CHIEF OPERATING OFFICER
Name	:	VICTOR L JOHNSON
Credential	:
Telephone Number	:	706-262-4455

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	01/18/2013

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