Individual
CHARLES LUKE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-5389
Mailing address
16198 SW 29TH ST, MIRAMAR, FL 33027-5217
(195) 444-1542
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
29741
FL
Other
Enumeration date
01/18/2023
Last updated
01/18/2023
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