Provider Demographics
NPI:1891027082
Name:RUTKOWSKI, RAYMOND (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:RUTKOWSKI
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 1:1686 WRIGHT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1091
Mailing Address - Country:US
Mailing Address - Phone:989-968-4003
Mailing Address - Fax:989-968-4005
Practice Address - Street 1:1686 WRIGHT AVE STE C
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1091
Practice Address - Country:US
Practice Address - Phone:989-968-4003
Practice Address - Fax:989-968-4005
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist