Provider Demographics
NPI:1316044662
Name:GARNER, RUSSELL ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ALAN
Last Name:GARNER
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 1:38485 WARRIQUE RD
Mailing Address - Street 2:
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866-2725
Mailing Address - Country:US
Mailing Address - Phone:757-859-9496
Mailing Address - Fax:757-899-3403
Practice Address - Street 1:105 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:VA
Practice Address - Zip Code:23888
Practice Address - Country:US
Practice Address - Phone:757-899-2551
Practice Address - Fax:757-899-3403
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202005095OtherPHARMACIST LICENSE NUMBER