Provider Demographics
NPI:1528222809
Name:ROUSSELL, ERIC M SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:M
Last Name:ROUSSELL
Suffix:SR
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 1:307 CRESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701
Mailing Address - Country:US
Mailing Address - Phone:334-874-7607
Mailing Address - Fax:334-874-7607
Practice Address - Street 1:1300 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-875-7309
Practice Address - Fax:334-877-4029
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist