Provider Demographics
NPI:1902131816
Name:BARRETT, RUSSELL FREDERICK
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:FREDERICK
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 MARCUS GARVEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1510
Mailing Address - Country:US
Mailing Address - Phone:718-443-8787
Mailing Address - Fax:
Practice Address - Street 1:276 MARCUS GARVEY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-1510
Practice Address - Country:US
Practice Address - Phone:718-443-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025421183500000X
NY25421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist