IndividualActive
Michael Russell, PHARMD
NPI 1780289504 · Pharmacist · Sullivan, IL
Provider details
- NPI number
- 1780289504
- Entity type
- Individual
- Primary specialty
- PharmacistPharmacy Service Providers
- Credential
- PHARMD
- Sex
- Male
- Sole proprietor
- No
- License
- 051.292600 (IL)
Specialties & taxonomies
Pharmacy Service Providers
Practice location
208 W Jackson St
Sullivan, IL 61951-1454
Phone: (217) 728-7216
Fax: (217) 728-2816
Approximate (ZIP-level) locationGet directions
Mailing address
208 W Jackson St
Sullivan, IL 61951-1454
Registry dates
- Enumerated
- 2020-12-01
- Last updated
- 2020-12-01
- Certified
- 2020-12-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.