Ryan Russell, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

P7514 Issued in ID

Practice address

415 6TH St
Lewiston, ID 83501-2431

Phone

(208) 799-5626

Fax

(208) 799-5424

NPI assigned

Jun 30, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1669823647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-799-5626",
            "fax_number": "208-799-5424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-799-5626",
            "fax_number": "208-799-5424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-30",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P7514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian T Ruddell, DC
• Kevin Patrick Ruddell, DC
• John Bradley Rudolph, D.O.
• Stephanie Lynn Ruggiero-Bodden, LMSW
• Pedro E Ruiz, D.M.D.
• S.P.O.R.T. Physical Therapy Clinic
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• S.P.O.R.T. Physical Therapy Clinic
• Kelsey Sadowski
• Jaymes Joseph William Sajczuk, DPT

• Pharmacist in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.