Provider Demographics
NPI:1639408347
Name:PATRICK, RUSSELL JR (RPH)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:PATRICK
Suffix:JR
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 1:4907 THOMASON DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-6309
Mailing Address - Country:US
Mailing Address - Phone:432-699-0907
Mailing Address - Fax:
Practice Address - Street 1:215 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6331
Practice Address - Country:US
Practice Address - Phone:432-682-8211
Practice Address - Fax:432-685-0628
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist