=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760552095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN BECK RUSSELL RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 W MAYFIELD RD SUITE 101
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76014-2083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-375-5485
-----------------------------------------------------
Fax | 817-467-9055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 W MAYFIELD RD SUITE 101
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76014-2083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-375-5485
-----------------------------------------------------
Fax | 817-467-9055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12257
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835X0200X
-----------------------------------------------------
Taxonomy Name | Oncology Pharmacist
-----------------------------------------------------
License Number | 26811
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------