Provider Demographics
NPI:1457620148
Name:TRUSSELL, KORI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:TRUSSELL
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 1:2900 SW WANAMAKER DR
Mailing Address - Street 2:STE 201N
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 SW WANAMAKER DR
Practice Address - Street 2:STE 201N
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4167
Practice Address - Country:US
Practice Address - Phone:316-265-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-25
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist