Healthcare Provider Details

I. General information

NPI: 1720903404
Provider Name (Legal Business Name): BRITTANY JADE RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 KY ROUTE 680 EAST
HAROLD KY
41635
US

IV. Provider business mailing address

6926 KY ROUTE 2030
BANNER KY
41603-8998
US

V. Phone/Fax

Practice location:
  • Phone: 606-478-1600
  • Fax:
Mailing address:
  • Phone: 606-331-1896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025948
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: