Individual
CHAZ RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2901 SW PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL 34953-3222
(772) 336-3108
Mailing address
2901 SW PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL 34953-3222
(772) 336-3108
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS66903
FL
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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