Provider Demographics
NPI:1386422830
Name:KUSZAK, NOAH CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:CHRISTOPHER
Last Name:KUSZAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1525
Mailing Address - Country:US
Mailing Address - Phone:402-525-4098
Mailing Address - Fax:
Practice Address - Street 1:16960 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2237
Practice Address - Country:US
Practice Address - Phone:402-289-9276
Practice Address - Fax:402-289-9278
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist