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NPI Code Detail

MEDICARE: NANCY D RUSSO RPH

MEDICARE: NANCY D RUSSO RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist6269CT
2183500000XPharmacist25573MA

General Provider Information

NPI Number : 1043760689
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY D RUSSO RPH
Provider Business Mailing Address
First Line : 20 HICKORY KNLS
Second Line :
City : NEW HARTFORD
State : CT
Zip : 06057-3329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6 THOMPSON RD
Second Line :
City : EAST WINDSOR
State : CT
Zip : 06088-9626
Country : US
Telephone Number : 866-809-4455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2016
Last Update Date : 10/06/2016

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Directions to “ NANCY D RUSSO RPH” Practice Location

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