Provider Demographics
NPI:1790388999
Name:ARAGON, RUSELLE JANINA FIDER (RPH)
Entity Type:Individual
Prefix:
First Name:RUSELLE JANINA
Middle Name:FIDER
Last Name:ARAGON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 N HIGHWAY 89
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5978
Mailing Address - Country:US
Mailing Address - Phone:928-636-8425
Mailing Address - Fax:
Practice Address - Street 1:1031 N HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5978
Practice Address - Country:US
Practice Address - Phone:928-636-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist