Individual
MARK RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH
Contact information
Practice address
999 N MAIN ST, LOGAN, UT 84321-3230
(435) 227-1100
Mailing address
14 S 490 E, SMITHFIELD, UT 84335-1220
(435) 563-2777
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7284773-1701
UT
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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