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General NPI Number Information
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NPI Number | 1811000441
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Entity Type | Individual
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Provider Name | SUSAN ANN RUSSELL RPH
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | I-40, EXIT 102
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City | SAN FIDEL
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State | NM
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Zip | 87049
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Country | US
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Telephone | 505-552-5394
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Fax | 505-552-5464
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Provider Business Mailing Address
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Address Line | 804 WASHINGTON AVE
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City | GRANTS
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State | NM
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Zip | 87020-3025
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Country | US
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Telephone | 505-552-5394
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Fax | 505-552-5464
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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 | 00005516
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License Number State | NM
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