Provider Demographics
NPI:1023399078
Name:RUSSO, ALEJANDRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35800 HWY 27
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-3735
Mailing Address - Country:US
Mailing Address - Phone:863-422-6661
Mailing Address - Fax:
Practice Address - Street 1:35800 HWY 27
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3735
Practice Address - Country:US
Practice Address - Phone:863-422-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist