Organization
RUTLEDGE PHARMACY AND MEDICAL SUPPLIES LLC
Active
Other names
RUTLEDGE PHARMACY AND MEDICAL SUPPLIES
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN IKE (PRESIDENT)
(770) 265-1740
Entity
Organization
Contact information
Practice address
2470 LEONE AVE STE E, LOGANVILLE, GA 30052-6147
(770) 728-9624
(770) 728-9729
Mailing address
2470 LEONE AVE, SUITE E, LOGANVILLE, GA 30052-6169
(770) 728-9624
(770) 728-9729
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009924
GA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140429
PK
—
Enumeration date
05/21/2013
Last updated
06/19/2014
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