Individual
KYLE A RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
220 S ST, HWY OK- 97, SAND SPRINGS, OK 74063
(918) 245-9523
Mailing address
2750 N 7TH ST APT 4121, BROKEN ARROW, OK 74012-2874
(918) 407-9859
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17542
OK
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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