Provider Demographics
NPI:1124801840
Name:RUSSELL, CLARE ALEXANDRIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CLARE
Middle Name:ALEXANDRIA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1104
Mailing Address - Country:US
Mailing Address - Phone:608-222-8651
Mailing Address - Fax:608-222-2184
Practice Address - Street 1:108 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1104
Practice Address - Country:US
Practice Address - Phone:608-222-8651
Practice Address - Fax:608-222-2184
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22297-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist