MARY RUTAN INDIAN LAKE PHARMACY
NPI 1790665172
Pharmacy - Community/Retail Pharmacy in Russells Point, OH

Q: What is Mary Rutan Indian Lake Pharmacy's NPI number?

The NPI number for Mary Rutan Indian Lake Pharmacy is 1790665172. It was assigned to this organization in the NPPES registry on September 5, 2025.

Q: What is Mary Rutan Indian Lake Pharmacy's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Active since September 05, 2025CLIA 36D2163056 · Waiver

120 W MAIN ST, RUSSELLS POINT, OH 43348(937) 292-5024(937) 292-3576 Get Directions Write a Review

NPPES record last updated: December 19, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 19, 2025, Sep 5, 2025 (2 updates tracked since 2025).

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About Mary Rutan Indian Lake Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY RUTAN INDIAN LAKE PHARMACY (NPI 1790665172) is a healthcare organization registered as a community/retail pharmacy in Russells Point, Ohio and active in the NPI registry since September 2025. The organization holds a CLIA Waiver certificate valid through March 5, 2027 and lists Christina Myers, Coo, as its authorized official.

NPPES Registry Identity

NPI1790665172

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameMARY RUTAN INDIAN LAKE PHARMACY

Location Address120 W MAIN STRussells Point, OH 43348-7500

Mailing Address205 E Palmer RdBellefontaine, OH 43311-2281 · (937) 292-5024 · Fax (937) 292-3576

Phone(937) 292-5024

Fax(937) 292-3576

Organization SubpartNo

Authorized OfficialChristina MyersCoo · (937) 599-7034

Enumeration DateSeptember 5, 2025

Last NPPES UpdateDecember 19, 20252 updates tracked since enumeration

NPPES CertifiedDecember 19, 2025

✔ NPI 1790665172 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

Definition

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.

Also ListedPharmacyTaxonomy 333600000X

120 W MAIN ST, Russells Point, OH 43348

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 36D2163056

Mary Rutan Indian Lake Health Center · Russells Point, OH

Active · expires Mar 5, 2027

CLIA Number36D2163056

Laboratory TypeHospital

Certificate Effective DateMarch 6, 2025

Certificate Expiration DateMarch 5, 2027

Laboratory DirectorDr. Anthony Beisler

Laboratory Phone(937) 292-5063

Laboratory LocationMary Rutan Indian Lake Health Center120 W Main St Suite 8, Russells Point, OH 43348

CLIA data matches this NPI record on: Address

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNICA ALAN HERROD-GONZALEZ CPHT

Pharmacy Technician

120 W MAIN ST
RUSSELLS POINT, OH 43348

Logan County (937) 843-2048

HEATHER RAYCHEL LEEZER

Pharmacist

120 W MAIN ST
RUSSELLS POINT, OH 43348

Logan County (937) 292-5024

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Rutan Indian Lake Pharmacy's NPI number?

The NPI number for Mary Rutan Indian Lake Pharmacy is 1790665172. It was assigned to this organization in the NPPES registry on September 5, 2025.

Where is Mary Rutan Indian Lake Pharmacy located?

Mary Rutan Indian Lake Pharmacy is located at 120 W Main St, Russells Point, OH 43348. The listed phone number is (937) 292-5024.

What is Mary Rutan Indian Lake Pharmacy's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Mary Rutan Indian Lake Pharmacy hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 36D2163056) is associated with this NPI, valid through March 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mary Rutan Indian Lake Pharmacy was last updated on December 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.