Provider Demographics
NPI:1316088420
Name:KUSHNER, JOHN H (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 WESTERN PINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1424
Mailing Address - Country:US
Mailing Address - Phone:941-377-4756
Mailing Address - Fax:941-371-6108
Practice Address - Street 1:1256 WESTERN PINE CIRCLE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1424
Practice Address - Country:US
Practice Address - Phone:941-377-4756
Practice Address - Fax:941-371-6108
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist