# RUTLEDGE PHARMACY AND MEDICAL SUPPLIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RUTLEDGE PHARMACY AND MEDICAL SUPPLIES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639515380
- **Authorized official:** CHRISTIAN IKE (PRESIDENT)
- **Authorized official phone:** (770) 265-1740

## Contact information

- **Practice address:** 2470 LEONE AVE STE E, LOGANVILLE, GA 30052-6147
- **Practice address phone:** (770) 728-9624
- **Practice address fax:** (770) 728-9729
- **Mailing address:** 2470 LEONE AVE, SUITE E, LOGANVILLE, GA 30052-6169
- **Mailing address phone:** (770) 728-9624
- **Mailing address fax:** (770) 728-9729

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009924 | GA | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/21/2013
- **Last updated:** 06/19/2014