Provider Demographics
NPI:1174823652
Name:RUSSO, CHRISTIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6006
Mailing Address - Country:US
Mailing Address - Phone:410-203-1212
Mailing Address - Fax:410-203-1216
Practice Address - Street 1:4370 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6006
Practice Address - Country:US
Practice Address - Phone:410-203-1212
Practice Address - Fax:410-203-1216
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist