=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073848727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARLA J RUSSELL R.PH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2009
-----------------------------------------------------
Last Update Date | 10/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7227 N 16TH ST STE 160
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85020-5293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-648-6252
-----------------------------------------------------
Fax | 602-678-0941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15210 N 44TH PL
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85032-4872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-214-8462
-----------------------------------------------------
Fax | 602-678-0941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S10106
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------