Individual
DR. GREGORY S RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
414 E DUPONT RD, FORT WAYNE, IN 46825-2050
(260) 490-3447
(260) 490-3457
Mailing address
414 E DUPONT RD, FORT WAYNE, IN 46825-2050
(260) 490-3447
(260) 490-3457
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26015397A
IN
Other
Enumeration date
11/08/2012
Last updated
11/08/2012
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