Healthcare Provider Details

I. General information

NPI: 1588679278
Provider Name (Legal Business Name): YELIZAVETA RUSS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

305 SW EDGEWAY DR APT 407
BEAVERTON OR
97006-3555
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax:
Mailing address:
  • Phone: 503-690-0351
  • Fax: 801-340-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number050511
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: