Provider Demographics
NPI:1124411210
Name:RUSSELL, RHONDA (RPH)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 HIGHWAY 134
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-9771
Mailing Address - Country:US
Mailing Address - Phone:318-816-8417
Mailing Address - Fax:
Practice Address - Street 1:388 HIGHWAY 134
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-9771
Practice Address - Country:US
Practice Address - Phone:318-816-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15521183500000X
TX34971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist