Provider Demographics
NPI:1316251721
Name:RUSSETT, FLINT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FLINT
Middle Name:
Last Name:RUSSETT
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 1:401 E SPRUCE ST
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5679
Mailing Address - Country:US
Mailing Address - Phone:620-272-2152
Mailing Address - Fax:
Practice Address - Street 1:401 E SPRUCE ST
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5679
Practice Address - Country:US
Practice Address - Phone:620-272-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14065183500000X, 1835G0303X, 1835N1003X, 1835P0018X, 1835P1200X
KY0129161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy