Provider Demographics
NPI:1093127524
Name:RUSSO, SHARON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:RUSSO
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:PO BOX 28904
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-0904
Mailing Address - Country:US
Mailing Address - Phone:360-733-7799
Mailing Address - Fax:
Practice Address - Street 1:3150 ORLEANS STREET BOX 28904
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98228
Practice Address - Country:US
Practice Address - Phone:386-503-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00071808183500000X
FLPS42568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist