Provider Demographics
NPI:1861921090
Name:RUSSO, CARA ANNE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:ANNE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:ANNE
Other - Last Name:KAPUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:1525 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-3411
Mailing Address - Country:US
Mailing Address - Phone:602-439-9867
Mailing Address - Fax:
Practice Address - Street 1:1525 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3411
Practice Address - Country:US
Practice Address - Phone:602-439-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist