Provider Demographics
NPI:1396029955
Name:RUSSIE, CHRISTA (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:RUSSIE
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 1:204 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3720
Mailing Address - Country:US
Mailing Address - Phone:678-583-5381
Mailing Address - Fax:678-583-7312
Practice Address - Street 1:204 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3720
Practice Address - Country:US
Practice Address - Phone:678-583-5381
Practice Address - Fax:678-583-7312
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist