Active NPI
Russell T Lederhouse, PHARMD
- Pharmacist
- Winchester, VA
National Provider Identifier
1053584045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202207604
- Practice address
- 2207 Valley Ave
Winchester, VA 22601-2755 - Phone
- (540) 667-0330
- NPI assigned
- Apr 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202207604 | VA | Primary |
Addresses
Primary practice location
2207 Valley Ave
Winchester, VA 22601-2755
Mailing address
54 Fawn Haven CT
Martinsburg, WV 25405-5858
Phone (304) 262-0104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202207604 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207785600000",
"number": "1053584045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54 FAWN HAVEN CT",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254055858",
"telephone_number": "304-262-0104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2207 VALLEY AVE",
"city": "WINCHESTER",
"state": "VA",
"postal_code": "226012755",
"telephone_number": "540-667-0330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEDERHOUSE",
"first_name": "RUSSELL",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-10",
"last_updated": "2008-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202207604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winchester, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.