Provider Demographics
NPI:1073708988
Name:RUSSELL, REBECCA LYNN QUANT (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN QUANT
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PLAGEMAN BUILDING
Mailing Address - Street 2:OREGON STATE UNIVERSITY
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-5801
Mailing Address - Country:US
Mailing Address - Phone:541-737-3491
Mailing Address - Fax:541-737-7616
Practice Address - Street 1:109 PLAGEMAN BUILDING
Practice Address - Street 2:OREGON STATE UNIVERSITY
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5801
Practice Address - Country:US
Practice Address - Phone:541-737-3491
Practice Address - Fax:541-737-7616
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010866183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist