Provider Demographics
NPI:1184914624
Name:RUSSEL, ROBERT LEWIS (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:RUSSEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 N COLUMBIA CENTER BLVD
Mailing Address - Street 2:STE 845
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2455
Mailing Address - Country:US
Mailing Address - Phone:509-783-3413
Mailing Address - Fax:509-735-2803
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:STE 845
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2455
Practice Address - Country:US
Practice Address - Phone:509-783-3413
Practice Address - Fax:509-735-2803
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00056215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist