Provider Demographics
NPI:1184060675
Name:RUSSELL, MEGAN (RPH, PHARM D)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140B ESTATE ST GEORGE
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00840
Mailing Address - Country:US
Mailing Address - Phone:340-718-6784
Mailing Address - Fax:340-719-6784
Practice Address - Street 1:140B ESTATE ST. GEORGE
Practice Address - Street 2:
Practice Address - City:ST. CROIX
Practice Address - State:VI
Practice Address - Zip Code:00840
Practice Address - Country:US
Practice Address - Phone:340-718-6784
Practice Address - Fax:340-719-6784
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI369183500000X
FLPS53233183500000X
IN26024894A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist