Provider Demographics
NPI:1912140898
Name:RUTLEDGE SMITH, ROXANNE (RPH)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:RUTLEDGE SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 MANOA LN N
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2432
Mailing Address - Country:US
Mailing Address - Phone:419-842-0882
Mailing Address - Fax:419-842-0881
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4366
Practice Address - Country:US
Practice Address - Phone:517-263-0603
Practice Address - Fax:517-266-9272
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03112413183500000X
MI5302030498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist