# MARY RUTAN INDIAN LAKE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790665172
- **Authorized official:** CHRISTINA MYERS (COO)
- **Authorized official phone:** (937) 599-7034

## Contact information

- **Practice address:** 120 W MAIN ST, RUSSELLS POINT, OH 43348-7500
- **Practice address phone:** (937) 292-5024
- **Practice address fax:** (937) 292-3576
- **Mailing address:** 205 E PALMER RD, BELLEFONTAINE, OH 43311-2281
- **Mailing address phone:** (937) 292-5024
- **Mailing address fax:** (937) 292-3576

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/05/2025
- **Last updated:** 12/19/2025