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General NPI Number Information
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NPI Number | 1134957327
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Entity Type | Individual
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Provider Name | DELVIN RUSSELL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 6019 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2113
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Country | US
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Telephone | 901-226-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 3549 GREENSIDE DR APT 303
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City | MEMPHIS
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State | TN
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Zip | 38125-0719
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Country | US
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Telephone | 901-406-5339
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Fax |
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 47550
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License Number State | TN
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