Provider Demographics
NPI:1831322163
Name:EASTER, RUSSELL M
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:M
Last Name:EASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SUDDERTH DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6025
Mailing Address - Country:US
Mailing Address - Phone:575-257-1566
Mailing Address - Fax:575-257-4600
Practice Address - Street 1:138 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6025
Practice Address - Country:US
Practice Address - Phone:575-257-1566
Practice Address - Fax:575-257-4600
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist