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General NPI Number Information
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NPI Number | 1326904384
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Entity Type | Individual
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Provider Name | GREG RUSSELL RPH
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Gender | Male
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Dates
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Enumeration Date | 01/02/2026
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 3408 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-4608
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Country | US
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Telephone | 502-912-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 WINDSONG WAY
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City | LOUISVILLE
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State | KY
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Zip | 40207-2285
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Country | US
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Telephone | 502-912-9879
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 010890
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License Number State | KY
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