Provider Demographics
NPI:1134729791
Name:RUSSO, JOHN P (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:RUSSO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:P
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:608 E HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2254
Mailing Address - Country:US
Mailing Address - Phone:724-674-9304
Mailing Address - Fax:
Practice Address - Street 1:608 E HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2254
Practice Address - Country:US
Practice Address - Phone:724-674-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031319L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy