Provider Demographics
NPI:1316929425
Name:RUSSELL, KATHLEEN SMITH (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SMITH
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 1:24 SUMMER MORNING CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2830
Mailing Address - Country:US
Mailing Address - Phone:281-363-3649
Mailing Address - Fax:713-442-1995
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4100
Practice Address - Country:US
Practice Address - Phone:713-442-1995
Practice Address - Fax:713-442-1995
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145527Medicaid