Provider Demographics
NPI:1134731979
Name:RUTKEY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:RUTKEY
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 1:585 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2032
Mailing Address - Country:US
Mailing Address - Phone:617-825-2401
Mailing Address - Fax:617-825-3425
Practice Address - Street 1:585 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2032
Practice Address - Country:US
Practice Address - Phone:617-825-2401
Practice Address - Fax:617-825-3425
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist