Provider Demographics
NPI:1356235857
Name:RUTOH, ASCAH
Entity type:Individual
Prefix:
First Name:ASCAH
Middle Name:
Last Name:RUTOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SOUTHERN CT
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5340
Mailing Address - Country:US
Mailing Address - Phone:601-927-9739
Mailing Address - Fax:
Practice Address - Street 1:622 SOUTHERN CT
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5340
Practice Address - Country:US
Practice Address - Phone:601-927-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist