Individual
MRS. BONNIE PORTER RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
910 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2519
(270) 769-3717
(270) 769-2887
Mailing address
40 HOLLY HILL DR, ELIZABETHTOWN, KY 42701-8917
(270) 737-4245
(270) 769-2887
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
006991
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006992
PHARMACIST LICENSCE NUMBE
KY
Enumeration date
10/25/2005
Last updated
07/08/2007
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