Provider Demographics
NPI:1811249717
Name:RUSSELL, MINDY (PHARMD)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BERMUDA ISLE CIRCLE
Mailing Address - Street 2:APT. 328
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-1749
Mailing Address - Country:US
Mailing Address - Phone:419-461-6812
Mailing Address - Fax:
Practice Address - Street 1:1800 SAN MARCO RD
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-6721
Practice Address - Country:US
Practice Address - Phone:419-461-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist