Individual
MRS. SUSAN ANN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
I-40, EXIT 102, SAN FIDEL, NM 87049
(505) 552-5394
(505) 552-5464
Mailing address
804 WASHINGTON AVE, GRANTS, NM 87020-3025
(505) 552-5394
(505) 552-5464
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
00005516
NM
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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