MEDICARE: RUSSELL G STRINGHAM R. PH.

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	16933	CO
2	183500000X	Pharmacist	333694-1701	UT

General Provider Information

NPI Number	:	1437592227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL G STRINGHAM R. PH.

Provider Business Mailing Address
First Line	:	2325 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1721
Country	:	US
Telephone Number	:	970-484-1410
Fax Number	:	970-484-3083

Provider Business Practice Location Address
First Line	:	2325 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1721
Country	:	US
Telephone Number	:	970-484-1410
Fax Number	:	970-484-3083

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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