Provider Demographics
NPI:1972634871
Name:RUSSO, KAREN HARRIS (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:HARRIS
Last Name:RUSSO
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 1:925 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-1907
Mailing Address - Country:US
Mailing Address - Phone:757-588-8794
Mailing Address - Fax:
Practice Address - Street 1:1701 WILL O WISP DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3102
Practice Address - Country:US
Practice Address - Phone:757-362-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist