Individual
LORIE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2130 W JEFFERSON ST, JOLIET, IL 60435-6622
(815) 725-1102
(815) 725-7500
Mailing address
116 E 3RD ST, BRAIDWOOD, IL 60408-1512
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
—
IL
Other
Enumeration date
02/21/2007
Last updated
07/08/2007
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