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NPI Code Detail

MEDICARE: DR. SHAY RUSSELL PHARMD

MEDICARE: DR. SHAY RUSSELL PHARMD
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
1183500000XPharmacist22765NC

General Provider Information

NPI Number : 1609229293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAY RUSSELL PHARMD
Provider Business Mailing Address
First Line : 269 S MAIN ST
Second Line : PO BOX 617
City : NORWOOD
State : NC
Zip : 28128-6435
Country : US
Telephone Number : 704-474-4171
Fax Number : 704-474-0177
Provider Business Practice Location Address
First Line : 269 S MAIN ST
Second Line :
City : NORWOOD
State : NC
Zip : 28128-6435
Country : US
Telephone Number : 704-474-4171
Fax Number : 704-474-0177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2016
Last Update Date : 07/19/2016

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Directions to “ DR. SHAY RUSSELL PHARMD” Practice Location

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