Provider Demographics
NPI:1558698894
Name:AIKEN, RUSSELL JAMES (PHARM D)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:JAMES
Last Name:AIKEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 NYS ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:PALATINE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13428
Mailing Address - Country:US
Mailing Address - Phone:518-673-2366
Mailing Address - Fax:
Practice Address - Street 1:6025 NYS ROUTE 5
Practice Address - Street 2:
Practice Address - City:PALATINE BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13428
Practice Address - Country:US
Practice Address - Phone:518-673-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052980OtherLICENSE