MEDICARE: RUSSELL MICHAEL DEA

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
1	183500000X	Pharmacist	89116	CA

General Provider Information

NPI Number	:	1235994393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL MICHAEL DEA

Provider Business Mailing Address
First Line	:	4539 LONE PINE LN
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-1555
Country	:	US
Telephone Number	:	818-439-3942
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 LONE PINE LN
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-1555
Country	:	US
Telephone Number	:	818-439-3942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

Similar Medicare Providers

1659696912 — ANDREA D. GERMOND M.D.
Practice Location Address:

1101 MEDICARE CTR. BLVD. , HOSPITALIST DEPARTMENT
MARRERO, LA
70072

Practice Phone: 504-349-1656
Practice Fax: 504-349-1933

1346822624 — LARA WELFORD
Practice Location Address:

1712 WALNUT ST
LA GRANDE, OR
97850-1555

Practice Phone: 541-200-0826
Practice Fax:

1124075346 — DR. MAGA E JACKSON-TRICHE M.D.
Practice Location Address:

1555 POYDRAS ST
NEW ORLEANS, LA
70112-3701

Practice Phone: 504-589-5913
Practice Fax: 504-589-5211

1336184282 — DR. LOREN WILKENFELD PH.D., ABPP
Practice Location Address:

1555 POYDRAS ST , SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM
NEW ORLEANS, LA
70112-3701

Practice Phone: 504-556-7309
Practice Fax:

1710917414 — DR. GREGORY LYON GLOWACKI M.D.
Practice Location Address:

1555 GARY DR STE A
BREAUX BRIDGE, LA
70517-3448

Practice Phone: 337-909-2474
Practice Fax: 337-909-2479

1073535704 — ROBERT STEPHEN PERRET MD
Practice Location Address:

1555 POYDRAS ST
NEW ORLEANS, LA
70112-3701

Practice Phone: 504-261-6090
Practice Fax:

Directions to “ RUSSELL MICHAEL DEA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.