Provider Demographics
NPI:1699883298
Name:IMBLER, RUSSELL STEVEN (RPH)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:STEVEN
Last Name:IMBLER
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 1:7016 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-1675
Mailing Address - Country:US
Mailing Address - Phone:812-867-1752
Mailing Address - Fax:
Practice Address - Street 1:8770 GUION RD
Practice Address - Street 2:SUITE G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3042
Practice Address - Country:US
Practice Address - Phone:317-829-0550
Practice Address - Fax:317-829-0545
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013574A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist