Ryan Michael Russell, PHARMD.

Primary specialty

PharmacistTaxonomy code 183500000X

License

2006024046 Issued in MO

Practice address

12266 De Paul Dr
Suite 105
Bridgeton, MO 63044-2514

Phone

(314) 344-7300

Fax

(314) 344-7179

NPI assigned

May 18, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1245465467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 RUSSELL BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041536",
            "telephone_number": "314-771-3269",
            "fax_number": "314-344-6179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12266 DE PAUL DR",
            "address_2": "SUITE 105",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442514",
            "telephone_number": "314-344-7300",
            "fax_number": "314-344-7179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "RYAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PHARMD.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-18",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2006024046",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051287298",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606172302",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy Rowlett, MAC, LPC
• Celsey Louise Royer, OTR/L
• Makayla Trenay Royston, CNA
• Gregory Wayne Rubel, PT
• Ashley Rupkey
• Taren Ashley Rutz, CRNA
• Sheila Saavedra, RN
• Majorie Virginia Sackman, BSW
• Kaycilee Sackmann
• Saint Louis Health Services LLC

• Pharmacist in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.