Provider Demographics
NPI:1851575815
Name:SANBORN, RUSSELL CHRISTOPHER (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:CHRISTOPHER
Last Name:SANBORN
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 1:5396 STATE HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3211
Mailing Address - Country:US
Mailing Address - Phone:607-334-6029
Mailing Address - Fax:607-334-5239
Practice Address - Street 1:5396 STATE HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3211
Practice Address - Country:US
Practice Address - Phone:607-334-6029
Practice Address - Fax:607-334-5239
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist