Individual
HOLLY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
407 N STATE ST, DESLOGE, MO 63601-3053
(573) 431-8563
Mailing address
PO BOX 324, FARMINGTON, MO 63640-0324
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2014026385
MO
Other
Enumeration date
11/01/2020
Last updated
11/01/2020
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