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General NPI Number Information
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NPI Number | 1417226101
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Entity Type | Individual
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Provider Name | MR. JERRY F RUSSELL JR.
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Gender | Male
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Dates
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Enumeration Date | 12/24/2011
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1455 UPPER MANATEE RIVER RD
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City | BRADENTON
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State | FL
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Zip | 34212-9702
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Country | US
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Telephone | 941-462-1564
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 UPPER MANATEE RIVER RD
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City | BRADENTON
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State | FL
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Zip | 34212-9702
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Country | US
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Telephone |
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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 | PS021868
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License Number State | FL
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