Individual
ACQUANETTA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
1400 JACKSON ST, DENVER, CO 80206-2761
(303) 388-4461
(303) 270-2174
Mailing address
1400 JACKSON ST, DENVER, CO 80206-2761
(303) 388-4461
(303) 270-2174
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
002
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060105291689678
PHARMACY CERTIFICATION#
CO
Enumeration date
01/12/2007
Last updated
07/08/2007
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