Individual
MRS. ELIZABETH RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
164 MAIN ST, SAUGUS, MA 01906-3271
(781) 231-5775
Mailing address
164 MAIN ST, SAUGUS, MA 01906-3271
(781) 231-5775
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH24194
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH24194
PHARMACY LICENSE
MA
Enumeration date
12/17/2020
Last updated
12/17/2020
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