Provider Demographics
NPI:1093980146
Name:RUSSELL, JOSEPH PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:RUSSELL
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 1:204 E BRUNSON ST
Mailing Address - Street 2:P O BOX 311688
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1922
Mailing Address - Country:US
Mailing Address - Phone:334-347-6865
Mailing Address - Fax:334-393-0679
Practice Address - Street 1:204 E BRUNSON ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1922
Practice Address - Country:US
Practice Address - Phone:334-347-6865
Practice Address - Fax:334-393-0679
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist