Individual
DR. RYAN MICHAEL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
12266 DE PAUL DR, SUITE 105, BRIDGETON, MO 63044-2514
(314) 344-7300
(314) 344-7179
Mailing address
2911 RUSSELL BLVD, SAINT LOUIS, MO 63104-1536
(314) 771-3269
(314) 344-6179
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051287298
IL
183500000X
Pharmacist
Primary
2006024046
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
606172302
—
MO
Enumeration date
05/18/2009
Last updated
12/21/2016
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