Individual
MR. RYAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-5626
(208) 799-5424
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-5626
(208) 799-5424
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7514
ID
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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