Individual
MR. CHARLES V RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
906 JANIS ST, NEW ROADS, IA 70760-2920
(225) 638-6088
(225) 638-6088
Mailing address
906 JANIS ST, NEW ROADS, IA 70760-2920
(225) 638-5151
(225) 638-5148
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9973
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234371
—
LA
Enumeration date
11/23/2007
Last updated
11/23/2007
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