Provider Demographics
NPI:1477154870
Name:RUSSELL, BRIAN E (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8415
Mailing Address - Country:US
Mailing Address - Phone:618-920-3460
Mailing Address - Fax:
Practice Address - Street 1:1195 BARRETT BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-7508
Practice Address - Country:US
Practice Address - Phone:270-826-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist