Healthcare Provider Details

I. General information

NPI: 1699883298
Provider Name (Legal Business Name): RUSSELL STEVEN IMBLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 GUION RD SUITE G
INDIANAPOLIS IN
46268-3042
US

IV. Provider business mailing address

7016 COPPERFIELD DR
EVANSVILLE IN
47711-1675
US

V. Phone/Fax

Practice location:
  • Phone: 317-829-0550
  • Fax: 317-829-0545
Mailing address:
  • Phone: 812-867-1752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26013574A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: