Individual
CHANDRA NICHOLE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3116 S GARNETT RD, TULSA, OK 74146-1933
(918) 622-7923
Mailing address
2750 N 7TH ST APT 4121, BROKEN ARROW, OK 74012-2874
(918) 606-8286
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18136
PW
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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