Provider Demographics
NPI:1598065070
Name:RUSSELL, KEVIN E (RPH, BCACP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:RPH, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 S HIGHWAY 97 STE 150
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0320
Mailing Address - Country:US
Mailing Address - Phone:541-609-0306
Mailing Address - Fax:
Practice Address - Street 1:2127 S HIGHWAY 97 STE 150
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-0320
Practice Address - Country:US
Practice Address - Phone:541-609-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8618183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist