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General NPI Number Information
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NPI Number | 1881151942
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Entity Type | Individual
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Provider Name | CANDACE RAE RUSSO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 8915 TOWNE CENTRE DR
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City | SAN DIEGO
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State | CA
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Zip | 92122-5650
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Country | US
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Telephone | 858-550-9066
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Fax |
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Provider Business Mailing Address
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Address Line | 701 W BEECH ST STE 503
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City | SAN DIEGO
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State | CA
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Zip | 92101-2669
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Country | US
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Telephone | 979-567-1177
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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 | 79660
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License Number State | CA
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