Provider Demographics
NPI:1952623480
Name:RUSS, PATRICIA CECELIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:CECELIA
Last Name:RUSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NYE HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2649
Mailing Address - Country:US
Mailing Address - Phone:716-655-1428
Mailing Address - Fax:
Practice Address - Street 1:360 DINGENS ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-2319
Practice Address - Country:US
Practice Address - Phone:716-824-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist