MEDICARE: MR. RUSSEL MICHAEL ARNOLD PHARM.D., MBA

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	P7606	ID

General Provider Information

NPI Number	:	1467900506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSEL MICHAEL ARNOLD PHARM.D., MBA

Provider Business Mailing Address
First Line	:	805 E POLSTON AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-6044
Country	:	US
Telephone Number	:	208-777-7732
Fax Number	:	208-777-0201

Provider Business Practice Location Address
First Line	:	805 E POLSTON AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-6044
Country	:	US
Telephone Number	:	208-777-7732
Fax Number	:	208-777-0201

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

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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