Individual
DR. ANDREW KERN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH, PHARMD
Contact information
Practice address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-7000
Mailing address
MAIN PHARMACY, 2825 E BARNETT RD, MEDFORD, OR 97504
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0016047
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0016047
PHARMACIST LICENSE NUMBER
OR
Enumeration date
08/24/2017
Last updated
08/24/2017
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