Basic Information
| Provider Information | |||||||||
| NPI: | 1710084611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSS | ||||||||
| FirstName: | YUN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | R.PH. BCPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6617 SE COUGAR MOUNTAIN WAY | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980065608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067621010 | ||||||||
| FaxNumber: | 2067642572 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | VAPSHCS S-116-MHC | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062774500 | ||||||||
| FaxNumber: | 2067642572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 1835P1300X | PH00016799 | WA | Y | Pharmacy Service Providers | Pharmacist | Psychiatric |
No ID Information.