Individual
DONALD RAY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
8191 UPLAND BEND, CAMBY, IN 46113
(317) 856-9521
Mailing address
2353 BRENTFORD LANE, GREENWOOD, IN 46143-0135
(317) 258-7557
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26012545A
IN
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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