Russell Daniel Gardner, RPH
Individual provider Active NPI Pharmacist · Joshua, TX
NPI 1104977917 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104977917
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26372 (TX)
- Practice address
- 3521 B SW Wilshire
Joshua, TX 76058 - Phone
- (817) 484-3267
- Fax
- (817) 484-3628
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26372 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Best Value Pharmacies Inc | Past | Accepting new patients | |
| Best Value Pharmacies Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26372 | TX | Yes |
Addresses
Primary practice location
3521 B SW Wilshire
Joshua, TX 76058
Mailing address
164 SW Brushy Mound Rd
Burleson, TX 76028-3321
Phone (817) 295-5117
Other providers in Joshua, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.