Provider Demographics
NPI:1821216557
Name:RUTOWSKI, JEFFREY MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:RUTOWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 REGENCY CT
Mailing Address - Street 2:
Mailing Address - City:BOWMANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14026-1050
Mailing Address - Country:US
Mailing Address - Phone:716-685-5435
Mailing Address - Fax:
Practice Address - Street 1:4923 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5662
Practice Address - Country:US
Practice Address - Phone:716-627-3232
Practice Address - Fax:716-627-5018
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist