Healthcare Provider Details

I. General information

NPI: 1336191410
Provider Name (Legal Business Name): RUSSELL JAMES PELZEL RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 N HIGHWAY 377 STE 100
PILOT POINT TX
76258-3762
US

IV. Provider business mailing address

125 COUNTY ROAD 286
COLLINSVILLE TX
76233-2314
US

V. Phone/Fax

Practice location:
  • Phone: 940-686-0123
  • Fax:
Mailing address:
  • Phone: 903-436-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: