Rutledge Pharmacy and Medical Supplies LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009924 Issued in GA

Legal business name

RUTLEDGE PHARMACY AND MEDICAL SUPPLIES LLC

Doing business as

Rutledge Pharmacy and Medical Supplies

Practice address

2470 Leone Ave Ste E
Loganville, GA 30052-6147

Phone

(770) 728-9624

Fax

(770) 728-9729

NPI assigned

May 21, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christian Ike

Title

President

Phone

(770) 265-1740

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• RUTLEDGE PHARMACY AND MEDICAL SUPPLIES Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1639515380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2470 LEONE AVE",
            "address_2": "SUITE E",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300526169",
            "telephone_number": "770-728-9624",
            "fax_number": "770-728-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2470 LEONE AVE STE E",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300526147",
            "telephone_number": "770-728-9624",
            "fax_number": "770-728-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUTLEDGE PHARMACY AND MEDICAL SUPPLIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-21",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "IKE",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-265-1740"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009924",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140429",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RUTLEDGE PHARMACY AND MEDICAL SUPPLIES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Loganville, GA
• Providers in Loganville, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.