Provider Demographics
NPI:1073137683
Name:RUSSELL, KRISTEN LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEIGH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2450
Mailing Address - Country:US
Mailing Address - Phone:706-765-2000
Mailing Address - Fax:
Practice Address - Street 1:3355 LEXINGTON RD # RC
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2450
Practice Address - Country:US
Practice Address - Phone:706-765-2000
Practice Address - Fax:770-785-7257
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist