Provider Demographics
NPI:1871269589
Name:RUSSO, ANIEL DONALD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANIEL
Middle Name:DONALD
Last Name:RUSSO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 COOKE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3012
Mailing Address - Country:US
Mailing Address - Phone:877-955-0255
Mailing Address - Fax:
Practice Address - Street 1:461 COOKE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3012
Practice Address - Country:US
Practice Address - Phone:877-955-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist