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General NPI Number Information
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NPI Number | 1649339599
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Entity Type | Individual
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Provider Name | KIMBERLI C. RUSSELL RPH
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Gender | Female
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 777 N MAIN ST
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City | EPHRAIM
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State | UT
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Zip | 84627-1165
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Country | US
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Telephone | 435-283-8194
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Fax |
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Provider Business Mailing Address
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Address Line | 805 S 300 E
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City | EPHRAIM
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State | UT
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Zip | 84627-1610
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Country | US
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Telephone | 435-283-5758
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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 | 131561-1701
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License Number State | UT
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