Provider Demographics
NPI:1538416334
Name:RUTHERFORD, DOMINICK (PHARMD)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7123 MISSION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9555
Mailing Address - Country:US
Mailing Address - Phone:716-417-0637
Mailing Address - Fax:
Practice Address - Street 1:34841 VETERANS PLZ
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1733
Practice Address - Country:US
Practice Address - Phone:734-728-8306
Practice Address - Fax:734-728-8065
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist