Active NPI
Lisa Marie Russell, RPH
- Pharmacist
- Jasper, TX
National Provider Identifier
1649509498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 30278
- Practice address
- 1250 S Wheeler St
Jasper, TX 75951-5120 - Phone
- (498) 381-8396
- Fax
- (409) 384-7480
- NPI assigned
- Dec 8, 2009
- Last updated
- Dec 8, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 30278 | TX | Primary |
| Pharmacist | 183500000X | 051-290906 | IL |
Addresses
Primary practice location
1250 S Wheeler St
Jasper, TX 75951-5120
Mailing address
1250 S. Wheeler St
Jasper, TX 75951
Phone (498) 381-8396
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051-290906 | IL | MD | Pharmacist |
| 30278 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260230400000",
"number": "1649509498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1250 S. WHEELER ST",
"city": "JASPER",
"state": "TX",
"postal_code": "75951",
"telephone_number": "498-381-8396",
"fax_number": "409-384-7480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 S WHEELER ST",
"city": "JASPER",
"state": "TX",
"postal_code": "759515120",
"telephone_number": "498-381-8396",
"fax_number": "409-384-7480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "LISA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-08",
"last_updated": "2009-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "30278",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051-290906",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jasper, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.