Provider Demographics
NPI:1184131260
Name:RUSSELL, ANJALI HANDIEKAR
Entity type:Individual
Prefix:MRS
First Name:ANJALI
Middle Name:HANDIEKAR
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 SHELLY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7789
Mailing Address - Country:US
Mailing Address - Phone:704-578-8321
Mailing Address - Fax:
Practice Address - Street 1:231 MT HOLLY HUNTERSVILLE RD STE 160
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-9357
Practice Address - Country:US
Practice Address - Phone:704-827-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist