Provider Demographics
NPI:1174410021
Name:RUSSELL, BRYSON (PHARMD, MHA, MSC)
Entity type:Individual
Prefix:DR
First Name:BRYSON
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:PHARMD, MHA, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 DUBLIN ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1917
Mailing Address - Country:US
Mailing Address - Phone:970-388-2577
Mailing Address - Fax:
Practice Address - Street 1:2908 DUBLIN ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1917
Practice Address - Country:US
Practice Address - Phone:970-388-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-78738183500000X
COPHA.0023429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist