Provider Demographics
NPI:1205963022
Name:PATTI, RUSSELL ANTHONY JR (RPH NP)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ANTHONY
Last Name:PATTI
Suffix:JR
Gender:M
Credentials:RPH NP
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Mailing Address - Street 1:1770 SE HILLMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7534
Mailing Address - Country:US
Mailing Address - Phone:772-446-1100
Mailing Address - Fax:772-489-3797
Practice Address - Street 1:1707 NW SAINT LUCIE WEST BLVD STE 166
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2520
Practice Address - Country:US
Practice Address - Phone:772-446-1100
Practice Address - Fax:772-489-3797
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPS30759183500000X
FLNP3021835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear