Provider Demographics
NPI:1285938704
Name:RUTHERFORD, MARC TODD (PHARM D)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:TODD
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TOWN BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3146
Mailing Address - Country:US
Mailing Address - Phone:404-233-7480
Mailing Address - Fax:404-233-7484
Practice Address - Street 1:104 TOWN BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319
Practice Address - Country:US
Practice Address - Phone:404-233-7480
Practice Address - Fax:404-233-7484
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist