Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Rutan Indian Lake Pharmacy

Organization Pharmacy · NPI 1790665172

Mary Rutan Indian Lake Pharmacy is a Pharmacy in Russells Point, Ohio. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
2

Practice location Address checks out

120 W Main St
Russells Point, OH 43348-7500
Phone: (937) 292-5024
Fax: (937) 292-3576
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X
Pharmacy Taxonomy 333600000X

Record details

NPI number1790665172
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Christina Myers — Coo · (937) 599-7034
NPI enumeratedSeptember 5, 2025
Last updated in NPPESDecember 19, 2025
Certification dateDecember 19, 2025
Mailing address205 E Palmer Rd, Bellefontaine, OH 43311-2281

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