Provider Demographics
NPI:1366732125
Name:HASTINGS, RUSSELL (RPH)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:HASTINGS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-1420
Mailing Address - Country:US
Mailing Address - Phone:508-398-5097
Mailing Address - Fax:
Practice Address - Street 1:711 MAIN ST
Practice Address - Street 2:
Practice Address - City:DENNIS PORT
Practice Address - State:MA
Practice Address - Zip Code:02639-1420
Practice Address - Country:US
Practice Address - Phone:508-398-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist