Provider Demographics
NPI:1063797587
Name:RUSSELL, CONNIE LEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LEE
Last Name:RUSSELL
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 1:2244 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3313
Mailing Address - Country:US
Mailing Address - Phone:615-367-0733
Mailing Address - Fax:615-366-0964
Practice Address - Street 1:2244 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3313
Practice Address - Country:US
Practice Address - Phone:615-367-0733
Practice Address - Fax:615-366-0964
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist