Provider Demographics
NPI:1417517061
Name:FRIEDMAN, RUSSELL
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 SPRUCE ST, THE BARCLAY PHARMACY
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6790
Mailing Address - Country:US
Mailing Address - Phone:215-735-1410
Mailing Address - Fax:215-735-1411
Practice Address - Street 1:1736 SPRUCE ST, THE BARCLAY PHARMACY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6790
Practice Address - Country:US
Practice Address - Phone:215-735-1410
Practice Address - Fax:215-735-1411
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028031L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist