Provider Demographics
NPI:1962756973
Name:GILBERT, RUSSELL EARL JR (DPH)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:EARL
Last Name:GILBERT
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1621
Mailing Address - Country:US
Mailing Address - Phone:731-584-4711
Mailing Address - Fax:
Practice Address - Street 1:175 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1621
Practice Address - Country:US
Practice Address - Phone:731-584-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist