Provider Demographics
NPI:1609229293
Name:RUSSELL, SHAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAY
Middle Name:
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 1:269 S MAIN ST
Mailing Address - Street 2:PO BOX 617
Mailing Address - City:NORWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28128-6435
Mailing Address - Country:US
Mailing Address - Phone:704-474-4171
Mailing Address - Fax:704-474-0177
Practice Address - Street 1:269 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NC
Practice Address - Zip Code:28128-6435
Practice Address - Country:US
Practice Address - Phone:704-474-4171
Practice Address - Fax:704-474-0177
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist