Provider Demographics
NPI:1194543215
Name:RUTTER, COURTNEY MADISON (PHARMD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MADISON
Last Name:RUTTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2921
Mailing Address - Country:US
Mailing Address - Phone:740-366-9082
Mailing Address - Fax:
Practice Address - Street 1:955 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2921
Practice Address - Country:US
Practice Address - Phone:740-366-9082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist