Provider Demographics
NPI:1932140563
Name:RUSSETT, LINDA ROSE (RPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ROSE
Last Name:RUSSETT
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 1:2490 SPRINGREEN DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2555
Mailing Address - Country:US
Mailing Address - Phone:563-582-1094
Mailing Address - Fax:
Practice Address - Street 1:1000 LANGWORTHY ST
Practice Address - Street 2:MERCY EAST PHARMACY
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7313
Practice Address - Country:US
Practice Address - Phone:563-584-3405
Practice Address - Fax:563-584-3285
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist