MR. Kenneth Royal Russell JR., DPH

NPI #1285719799 in Scott Afb, Illinois

Provider Information

NPI Number: 1285719799
Entity Type: Individual
Name: MR. Kenneth Royal Russell JR., DPH
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Credential: DPH
Enumeration Date: Oct 25, 2006
Last Updated: Apr 19, 2018

Practice Location

Address: 310 W LOSEY ST
City: Scott Afb
State: Illinois
ZIP Code: 62225-5250
Phone: (618) 256-7345

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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