Individual
CODY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
31 6TH ST STE 101, MALONE, NY 12953-1246
(518) 317-4016
(518) 317-4018
Mailing address
31 6TH ST, MALONE, NY 12953-1246
(518) 317-4016
(518) 317-4018
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0121761
VT
183500000X
Pharmacist
Primary
063927
NY
Other
Enumeration date
10/02/2016
Last updated
10/28/2024
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