Provider Demographics
NPI:1457530792
Name:RUTLAND PHARMACY INC
Entity Type:Organization
Organization Name:RUTLAND PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-886-6261
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-0233
Mailing Address - Country:US
Mailing Address - Phone:508-886-6261
Mailing Address - Fax:508-886-2443
Practice Address - Street 1:18 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:MA
Practice Address - Zip Code:01543-0233
Practice Address - Country:US
Practice Address - Phone:508-886-6261
Practice Address - Fax:508-886-2443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTLAND PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0487140001Medicare NSC