MEDICARE: DONALD RAY RUSSELL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26012545A	IN

General Provider Information

NPI Number	:	1225631948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD RAY RUSSELL RPH

Provider Business Mailing Address
First Line	:	2353 BRENTFORD LANE
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-0135
Country	:	US
Telephone Number	:	317-258-7557
Fax Number	:

Provider Business Practice Location Address
First Line	:	8191 UPLAND BEND
Second Line	:
City	:	CAMBY
State	:	IN
Zip	:	46113
Country	:	US
Telephone Number	:	317-856-9521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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