Individual
KATHLEEN L RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
PO BOX PH, CHINLE, AZ 86503-8000
(928) 674-7414
(928) 674-7849
Mailing address
PO BOX PH, CHINLE, AZ 86503-8000
(928) 674-7414
(928) 674-7849
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S022267
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S022267
PHARMACIST LICENSE
AZ
Enumeration date
07/06/2017
Last updated
07/06/2017
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