MARY RUTAN INDIAN LAKE PHARMACY
NPI 1790665172
Pharmacy - Community/Retail Pharmacy in Russells Point, OH
NPI Status: Active since September 05, 2025
Contact Information
120 W MAIN ST
RUSSELLS POINT, OH
ZIP 43348
Phone: (937) 292-5024
Fax: (937) 292-3576
- Organization
- Pharmacy
- Community/Retail Pharmacy
- CLIA Number: 36D2163056
- CLIA Cert. Type: Hospital
- CLIA Exp. Date: 03-05-2027
About MARY RUTAN INDIAN LAKE PHARMACY
This page provides the complete NPI Profile along with additional information for Mary Rutan Indian Lake Pharmacy, a provider established in Russells Point, Ohio operating as a Pharmacy, focusing in community/retail pharmacy . The healthcare provider is registered in the NPI registry with number 1790665172 assigned on September 2025. The practitioner's primary taxonomy code is 3336C0003X. The provider is registered as an organization and their NPI record was last updated December 2025. The authorized official of this NPI record is Christina Myers (Coo)
- NPI
- 1790665172
- Provider Name
- MARY RUTAN INDIAN LAKE PHARMACY
- Entity Type
- Organization
- Location Address
- 120 W MAIN ST RUSSELLS POINT, OH 43348
- Location Phone
- (937) 292-5024
- Location Fax
- (937) 292-3576
- Mailing Address
- 205 E PALMER RD BELLEFONTAINE, OH 43311
- Mailing Phone
- (937) 292-5024
- Mailing Fax
- (937) 292-3576
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-05-2025
- Last Update Date
- 12-19-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pharmacy Community/Retail Pharmacy
- Taxonomy Code
- 3336C0003X
- Type
- Suppliers
- Taxonomy Description
- A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 333600000X | Suppliers | Pharmacy |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 36D2163056
- Facility Type
- Hospital
- Certificate Effective Date
- March 06, 2025
- Certificate Expiration Date
- March 05, 2027
- Laboratory Director
- DR. ANTHONY BEISLER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Mary Rutan Indian Lake Pharmacy to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1790665172, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 58. The final step is to find the difference between that total and the next multiple of ten (60 - 58 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 58 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1790665172, enumerated as an "organization" on September 05, 2025.
The provider is located at 120 W MAIN ST RUSSELLS POINT, OH 43348 and the phone number is (937) 292-5024.
Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.
