=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619099165
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABRINA NEVETTE RUSS PHARMD,NBC-HWC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 07/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 364 FOX SQUIRREL CIR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29209-4481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-602-6777
-----------------------------------------------------
Fax | 803-602-6777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 364 FOX SQUIRREL CIR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29209-4481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-602-6777
-----------------------------------------------------
Fax | 803-602-6777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | A-4042698
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10006
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1835G0303X
-----------------------------------------------------
Taxonomy Name | Geriatric Pharmacist
-----------------------------------------------------
License Number | 10006
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 10006
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------