Organization
RUSSOS HEALTH MART INC
Active
Other names
RUSSOS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SALVADORE RUSSO RPH (OWNER)
(985) 384-1234
Entity
Organization
Contact information
Practice address
1124 7TH ST, MORGAN CITY, LA 70380-1951
(985) 384-1234
(985) 384-1233
Mailing address
PO BOX 2703, MORGAN CITY, LA 70381-2703
(985) 384-1234
(985) 384-1233
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY000755IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1228796
—
LA
01
—
1908194
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/28/2007
Last updated
03/07/2011
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