=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275484834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUSSELL B KISH RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2026
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 WINDWARD CAY
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34114-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-877-1046
-----------------------------------------------------
Fax | 239-624-3762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 WINDWARD CAY
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34114-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-877-1046
-----------------------------------------------------
Fax | 239-624-3762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS28497
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------