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General NPI Number Information
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NPI Number | 1093980146
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Entity Type | Individual
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Provider Name | JOSEPH PAUL RUSSELL RPH
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Gender | Male
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 204 E BRUNSON ST
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City | ENTERPRISE
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State | AL
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Zip | 36330-1922
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Country | US
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Telephone | 334-347-6865
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Fax | 334-393-0679
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Provider Business Mailing Address
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Address Line | 204 E BRUNSON ST P O BOX 311688
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City | ENTERPRISE
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State | AL
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Zip | 36330-1922
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Country | US
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Telephone | 334-347-6865
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Fax | 334-393-0679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10723
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License Number State | AL
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