Provider Demographics
NPI:1548584543
Name:RUSSELL, TAMIKA D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAMIKA
Middle Name:D
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 SOUTHCREST CIR STE 108
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-8822
Mailing Address - Country:US
Mailing Address - Phone:662-349-2659
Mailing Address - Fax:662-349-2653
Practice Address - Street 1:391 SOUTHCREST CIR STE 108
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-349-2659
Practice Address - Fax:662-349-2659
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14649183500000X
TN13217183500000X
MST-15722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist