Holly Russell

NPI #1548860158 in Desloge, Missouri

Provider Information

NPI Number: 1548860158
Entity Type: Individual
Name: Holly Russell
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Enumeration Date: Nov 1, 2020
Last Updated: Nov 1, 2020

Practice Location

Address: 407 N STATE ST
City: Desloge
State: Missouri
ZIP Code: 63601-3053
Phone: (573) 431-8563

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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