Provider Demographics
NPI:1467900506
Name:ARNOLD, RUSSEL MICHAEL (PHARMD, MBA)
Entity Type:Individual
Prefix:MR
First Name:RUSSEL
Middle Name:MICHAEL
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6044
Mailing Address - Country:US
Mailing Address - Phone:208-777-7732
Mailing Address - Fax:208-777-0201
Practice Address - Street 1:805 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6044
Practice Address - Country:US
Practice Address - Phone:208-777-7732
Practice Address - Fax:208-777-0201
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist