Provider Demographics
NPI:1912219619
Name:KREBS, RUSSELL ALFRED JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ALFRED
Last Name:KREBS
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FAWNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1003
Mailing Address - Country:US
Mailing Address - Phone:412-787-2425
Mailing Address - Fax:
Practice Address - Street 1:623 E OHIO ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5619
Practice Address - Country:US
Practice Address - Phone:412-322-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027339L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183500000XMedicaid