Provider Demographics
NPI:1710295274
Name:GUYTON, RUSSELL B (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:B
Last Name:GUYTON
Suffix:
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 1:253 COUNTY ROAD 413
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-7828
Mailing Address - Country:US
Mailing Address - Phone:256-757-9036
Mailing Address - Fax:
Practice Address - Street 1:4150 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-2637
Practice Address - Country:US
Practice Address - Phone:256-757-3855
Practice Address - Fax:256-757-9544
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12922OtherSTATE LICENSE NUMBER