Provider Demographics
NPI:1275518672
Name:GEMMER, RUSSELL JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:JAMES
Last Name:GEMMER
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 1:5620 E LAKE BOSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-7741
Mailing Address - Country:US
Mailing Address - Phone:360-691-1166
Mailing Address - Fax:
Practice Address - Street 1:6602 64TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4834
Practice Address - Country:US
Practice Address - Phone:360-658-5218
Practice Address - Fax:360-658-5549
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00009752OtherSTATE LICENSE NUMBER