MEDICARE: DR. DENNIS L. RUSSELL R.P.

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	8583	NE

General Provider Information

NPI Number	:	1356385322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS L. RUSSELL R.P.

Provider Business Mailing Address
First Line	:	20725 S 5TH DR
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-6889
Country	:	US
Telephone Number	:	402-228-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 H ST
Second Line	:
City	:	FAIRBURY
State	:	NE
Zip	:	68352-1119
Country	:	US
Telephone Number	:	402-729-3351
Fax Number	:	402-729-2102

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/10/2007

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