Provider Demographics
NPI:1538443544
Name:RUSSELL, DAVID ALEXANDER (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5222
Mailing Address - Country:US
Mailing Address - Phone:508-620-1608
Mailing Address - Fax:508-620-6482
Practice Address - Street 1:653 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5222
Practice Address - Country:US
Practice Address - Phone:508-620-1608
Practice Address - Fax:508-620-6482
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist