Provider Demographics
NPI:1407143241
Name:RUTHSATZ, MOMO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOMO
Middle Name:
Last Name:RUTHSATZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 CAMPBELLTON FAIRBURN RD
Mailing Address - Street 2:PUBLIX
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5370 CAMPBELLTON FAIRBURN RD
Practice Address - Street 2:PUBLIX
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2296
Practice Address - Country:US
Practice Address - Phone:770-774-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist