1376099317 NPI number — MR. RUSSELL JOHN OSTARELLO PHARM D

Table of content: MR. RUSSELL JOHN OSTARELLO PHARM D (NPI 1376099317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376099317 NPI number — MR. RUSSELL JOHN OSTARELLO PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSTARELLO
Provider First Name:
RUSSELL
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376099317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 E ROMIE LN STE H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93901-4031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-424-0395
Provider Business Mailing Address Fax Number:
831-424-7949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1273 SOUT MAIN STREET
Provider Second Line Business Practice Location Address:
STAR PHARMACY AND GIFTS
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93901-4031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-621-5558
Provider Business Practice Location Address Fax Number:
831-621-5579
Provider Enumeration Date:
08/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH30356 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PHY54665 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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