Provider Demographics
NPI:1760552095
Name:RUSSELL, STEPHEN BECK (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BECK
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W MAYFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2083
Mailing Address - Country:US
Mailing Address - Phone:817-375-5485
Mailing Address - Fax:817-467-9055
Practice Address - Street 1:515 W MAYFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2083
Practice Address - Country:US
Practice Address - Phone:817-375-5485
Practice Address - Fax:817-467-9055
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12257183500000X
TX268111835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology