Provider Demographics
NPI:1760963961
Name:RUSSELL, LAURA MARY
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARY
Other - Last Name:BIELECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:726 EXCHANGE ST STE 522
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1485
Mailing Address - Country:US
Mailing Address - Phone:716-800-2273
Mailing Address - Fax:
Practice Address - Street 1:726 EXCHANGE ST STE 522
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-1485
Practice Address - Country:US
Practice Address - Phone:716-800-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist