Provider Demographics
NPI:1366768962
Name:RUSSELL, JOY (RPH)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
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 1:5275 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3502
Mailing Address - Country:US
Mailing Address - Phone:716-633-1781
Mailing Address - Fax:716-633-0039
Practice Address - Street 1:15 EARHART DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-7079
Practice Address - Country:US
Practice Address - Phone:716-929-1000
Practice Address - Fax:716-532-7360
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist