Provider Demographics
NPI:1205104692
Name:RUSSELL, DEVIN JORDAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:JORDAN
Last Name:RUSSELL
Suffix:
Gender:M
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:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:RED BOILING SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37150-0059
Mailing Address - Country:US
Mailing Address - Phone:615-699-2509
Mailing Address - Fax:615-699-4139
Practice Address - Street 1:126 MARKET ST
Practice Address - Street 2:
Practice Address - City:RED BOILING SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37150-2271
Practice Address - Country:US
Practice Address - Phone:615-699-2509
Practice Address - Fax:615-699-4139
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000028852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist