Individual
KRISTEN JADE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
600 STATE ST, SPRINGFIELD, MA 01109-4104
(413) 736-0351
Mailing address
106 PHILIPS AVE, SPRINGFIELD, MA 01119
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH237461
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH237461
BOARD OF PHARMACY
MA
Enumeration date
01/13/2018
Last updated
06/16/2018
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