Provider Demographics
NPI:1255933321
Name:TOBLER, RUSSELL TODD (PHARMD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:TODD
Last Name:TOBLER
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 1:625 W TELEGRAPH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-1541
Mailing Address - Country:US
Mailing Address - Phone:435-628-5424
Mailing Address - Fax:435-656-1180
Practice Address - Street 1:625 W TELEGRAPH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-1541
Practice Address - Country:US
Practice Address - Phone:435-628-5424
Practice Address - Fax:435-656-1180
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5081957-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist