MEDICARE: RUSSELL B KISH 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	PS28497	FL

General Provider Information

NPI Number	:	1275484834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL B KISH RPH

Provider Business Mailing Address
First Line	:	142 WINDWARD CAY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-9620
Country	:	US
Telephone Number	:	239-877-1046
Fax Number	:	239-624-3762

Provider Business Practice Location Address
First Line	:	142 WINDWARD CAY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-9620
Country	:	US
Telephone Number	:	239-877-1046
Fax Number	:	239-624-3762

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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