Provider Demographics
NPI:1114031291
Name:RUSSO, CHRISTOPHER GALILEO (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GALILEO
Last Name:RUSSO
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 1:8021 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5956
Mailing Address - Country:US
Mailing Address - Phone:972-723-2990
Mailing Address - Fax:
Practice Address - Street 1:1001 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2557
Practice Address - Country:US
Practice Address - Phone:972-923-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist