Individual
RUSSELL E MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH., M.S.
Contact information
Practice address
1481 W 10TH ST, PHARMACY SERVICE (119), INDIANAPOLIS, IN 46202-2803
(317) 988-2144
Mailing address
1481 W 10TH ST, PHARMACY SERVICE (119), INDIANAPOLIS, IN 46202-2803
(317) 988-2144
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26012680A
IN
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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