Active NPI
Kristen Jade Russo, PHARMD
- Pharmacist
- Springfield, MA
National Provider Identifier
1912415894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH237461
- Practice address
- 600 State St
Springfield, MA 01109-4104 - Phone
- (413) 736-0351
- NPI assigned
- Jan 13, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH237461 | MA | Primary |
Addresses
Primary practice location
600 State St
Springfield, MA 01109-4104
Mailing address
106 Philips Ave
Springfield, MA 01119
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH237461 | Other | MA | BOARD OF PHARMACY |
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH237461 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1912415894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 PHILIPS AVE",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "01119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 STATE ST",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "011094104",
"telephone_number": "413-736-0351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "KRISTEN",
"middle_name": "JADE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-13",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH237461",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHARMACY",
"identifier": "PH237461",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.