Basic Information
| Provider Information | |||||||||
| NPI: | 1073708988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LYNN QUANT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 PLAGEMAN BUILDING | ||||||||
| Address2: | OREGON STATE UNIVERSITY | ||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973315801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417373491 | ||||||||
| FaxNumber: | 5417377616 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 PLAGEMAN BUILDING | ||||||||
| Address2: | OREGON STATE UNIVERSITY | ||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973305801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417373491 | ||||||||
| FaxNumber: | 5417377616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 01/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH-0010866 | OR | Y | Pharmacy Service Providers | Pharmacist | 1835P0018X | RPH-0010866 | OR | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.