Provider Demographics
NPI:1033418280
Name:FRICK, RUSSELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:FRICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BLUE STONE CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7885
Mailing Address - Country:US
Mailing Address - Phone:803-381-7800
Mailing Address - Fax:
Practice Address - Street 1:2349 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4541
Practice Address - Country:US
Practice Address - Phone:803-794-7935
Practice Address - Fax:803-936-9678
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC006575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist