Provider Demographics
NPI:1225102759
Name:J RUTOWSKI INC
Entity Type:Organization
Organization Name:J RUTOWSKI INC
Other - Org Name:TILE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-632-6114
Mailing Address - Street 1:1031 CLEVELAND DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1221
Mailing Address - Country:US
Mailing Address - Phone:716-632-4888
Mailing Address - Fax:716-632-4488
Practice Address - Street 1:1031 CLEVELAND DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1221
Practice Address - Country:US
Practice Address - Phone:716-632-4888
Practice Address - Fax:716-632-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0016239333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00608508Medicaid
3365714OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY0158520001Medicare NSC