Russells Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301004374 Issued in MI

Legal business name

RUSSELLS PHARMACY LLC

Practice address

3011 W Grand Blvd
Suite 107
Detroit, MI 48202-3096

Phone

(313) 875-5384

Fax

(313) 875-5490

NPI assigned

Aug 29, 2006

Organization subpart

No

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

Authorized official

Name

Mohamed A Beydoun, PHARMD

Title

Owner

Phone

(313) 378-1938

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Russells Pharmacy Other name

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Locations

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760572800000",
    "number": "1801905476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 W GRAND BLVD STE 107",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023068",
            "telephone_number": "313-875-5384",
            "fax_number": "313-875-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 W GRAND BLVD",
            "address_2": "SUITE 107",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023096",
            "telephone_number": "313-875-5384",
            "fax_number": "313-875-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A",
        "authorized_official_last_name": "BEYDOUN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-378-1938",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301004374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2340292",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "2340292",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russells Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Manisha Russell
• Poshale Russell, LMSW
• Sarah Marie Russell, M.D.
• Warren Russell, LMSW
• Zoe H Russell, DO
• Andrew N. Russman, D.O.
• Lisa Marie Russo, LMSW
• Krystle Russow, RRT
• David H Rustom, M.D.
• Melissa Michele Ruszkiewicz, NP-C

• Community/Retail Pharmacy in Detroit, MI
• Providers in Detroit, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.