MEDICARE: DR. JANIS KAYE RUSSELL PHARMD, 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	PS51758	FL

General Provider Information

NPI Number	:	1912315847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANIS KAYE RUSSELL PHARMD, MBA

Provider Business Mailing Address
First Line	:	7970 BAYBERRY RD STE 4
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7474
Country	:	US
Telephone Number	:	904-327-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	7970 BAYBERRY RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-327-5290
Fax Number	:

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/13/2018

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