Provider Demographics
NPI:1144408766
Name:RUSS, WENDALYN JOY (RPH)
Entity type:Individual
Prefix:
First Name:WENDALYN
Middle Name:JOY
Last Name:RUSS
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 1:2787 CHARTER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-4607
Mailing Address - Country:US
Mailing Address - Phone:614-850-6677
Mailing Address - Fax:800-205-7408
Practice Address - Street 1:2787 CHARTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4607
Practice Address - Country:US
Practice Address - Phone:614-850-6677
Practice Address - Fax:800-205-7408
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-20100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist