Organization
LARRY J & BONNIE P RUSSELL
Active
Other names
The Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY RUSSELL R.PH. (OWNER)
(270) 769-3717
Entity
Organization
Contact information
Practice address
910 N DIXIE AVE STE 105, ELIZABETHTOWN, KY 42701-2519
(270) 769-3717
(270) 769-2887
Mailing address
910 N DIXIE AVE STE 105, ELIZABETHTOWN, KY 42701-2519
(270) 769-3717
(270) 769-2887
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
P01397
KY
3336C0003X
Community/Retail Pharmacy
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1813131
NCPDP #
KY
05
—
5401676100
—
KY
Enumeration date
10/25/2005
Last updated
03/07/2023
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