Provider Demographics
NPI:1710161914
Name:RUSSELL, CAROL ANN (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 SE HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4819
Mailing Address - Country:US
Mailing Address - Phone:561-422-5333
Mailing Address - Fax:561-422-7213
Practice Address - Street 1:7305 NORTH MILITARY TRAIL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6400
Practice Address - Country:US
Practice Address - Phone:561-422-5333
Practice Address - Fax:561-422-7213
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician