Provider Demographics
NPI:1437675428
Name:RUTOWSKI, KATHERINE THERESA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:THERESA
Last Name:RUTOWSKI
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 1:1031 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist