Provider Demographics
NPI:1235483645
Name:RUSSELL, ELIZABETH MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12 PLYMOUTH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2121
Mailing Address - Country:US
Mailing Address - Phone:508-754-8800
Mailing Address - Fax:508-754-8878
Practice Address - Street 1:12 PLYMOUTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2121
Practice Address - Country:US
Practice Address - Phone:508-754-8800
Practice Address - Fax:508-754-8878
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234500183500000X
MEPR6103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist