MEDICARE: RUSSELL GLENN ABERNATHY 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	10857	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306138813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL GLENN ABERNATHY RPH

Provider Business Mailing Address
First Line	:	301 US 70
Second Line	:
City	:	RUTHERFORD COLLEGE
State	:	NC
Zip	:	28671
Country	:	US
Telephone Number	:	828-874-2119
Fax Number	:	828-874-0161

Provider Business Practice Location Address
First Line	:	300 MAIN AVE W
Second Line	:
City	:	HILDEBRAN
State	:	NC
Zip	:	28637-8315
Country	:	US
Telephone Number	:	828-397-3420
Fax Number	:

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

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	01/16/2021

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