Provider Demographics
NPI:1942693205
Name:RUTLEDGE, ROSE
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:RUTLEDGE
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 1:2703 ROUTE 541
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4175
Mailing Address - Country:US
Mailing Address - Phone:609-239-9893
Mailing Address - Fax:609-479-4463
Practice Address - Street 1:2703 ROUTE 541
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4175
Practice Address - Country:US
Practice Address - Phone:609-239-9893
Practice Address - Fax:609-479-4463
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW00551200183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician