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General NPI Number Information
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NPI Number | 1447568365
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Entity Type | Individual
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Provider Name | ANDREA RUSSELL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 07/13/2019
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Provider Practice Location Address
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Address Line | 4881 SUGAR MAPLE DR
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City | WPAFB
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-904-0981
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Fax |
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Provider Business Mailing Address
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Address Line | 15301 WARREN SHINGLE RD
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City | BEALE AFB
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State | CA
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Zip | 95903-1907
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Country | US
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Telephone | 530-634-4819
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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 | 017396
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License Number State | KY
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