MEDICARE: ALEXANDRA RUSSO

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	28RI03965200	NJ
2	183500000X	Pharmacist	RP452868	PA

General Provider Information

NPI Number	:	1285273680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA RUSSO

Provider Business Mailing Address
First Line	:	142 S 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3409
Country	:	US
Telephone Number	:	877-882-9479
Fax Number	:	267-787-5568

Provider Business Practice Location Address
First Line	:	142 S 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3409
Country	:	US
Telephone Number	:	877-882-9479
Fax Number	:	267-787-5568

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

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	01/02/2020

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Directions to “ ALEXANDRA RUSSO ” Practice Location

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