Provider Demographics
NPI:1083865414
Name:RUTLEDGE, EDWIN DALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:DALE
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5325
Mailing Address - Country:US
Mailing Address - Phone:870-246-3044
Mailing Address - Fax:870-245-1738
Practice Address - Street 1:3002 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5325
Practice Address - Country:US
Practice Address - Phone:870-246-3044
Practice Address - Fax:870-245-1738
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist