Provider Demographics
NPI:1154745206
Name:DAVIS, RUSSELL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CARRETERA 857 & STATE RD 3
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-701-0808
Mailing Address - Fax:
Practice Address - Street 1:KM 130.1 CUATRO C
Practice Address - Street 2:PASEO DEL FARO PR
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-839-8505
Practice Address - Fax:787-839-5587
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist