Provider Demographics
NPI: | 1629316047 |
---|---|
Name: | RUTMEL, INC |
Entity Type: | Organization |
Organization Name: | RUTMEL, INC |
Other - Org Name: | LIVING WELL PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | R.PH., CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VICTOR |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 706-262-4455 |
Mailing Address - Street 1: | PO BOX 5 |
Mailing Address - Street 2: | |
Mailing Address - City: | GRACEWOOD |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30812-0005 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 706-262-4455 |
Mailing Address - Fax: | 706-262-4455 |
Practice Address - Street 1: | 3736 MIKE PADGETT HWY |
Practice Address - Street 2: | |
Practice Address - City: | AUGUSTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30906-0719 |
Practice Address - Country: | US |
Practice Address - Phone: | 706-262-4455 |
Practice Address - Fax: | 706-262-4455 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-01-18 |
Last Update Date: | 2013-01-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | PHRE009894 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |