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
StateLicense IDTaxonomies
GAPHRE0098943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy