Provider Demographics
NPI:1073848727
Name:RUSSELL, DARLA J (RPH)
Entity type:Individual
Prefix:MS
First Name:DARLA
Middle Name:J
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 1:15210 N 44TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4872
Mailing Address - Country:US
Mailing Address - Phone:602-214-8462
Mailing Address - Fax:602-678-0941
Practice Address - Street 1:7227 N 16TH ST STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5293
Practice Address - Country:US
Practice Address - Phone:602-648-6252
Practice Address - Fax:602-678-0941
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS10106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist