Individual
MISS AUDREY M RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACY TECH
Contact information
Practice address
719 HWY 19 SOUTH, PALATKA, FL 32177
(386) 328-6787
Mailing address
101 SANJAN DR, SATSUMA, FL 32189-2134
(386) 328-1338
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
RPT 17521
FL
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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