Provider Demographics
NPI:1588257000
Name:GUST, JOHN ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:GUST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1208 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1622
Mailing Address - Country:US
Mailing Address - Phone:218-879-4547
Mailing Address - Fax:218-878-1804
Practice Address - Street 1:1208 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1622
Practice Address - Country:US
Practice Address - Phone:218-879-4547
Practice Address - Fax:218-878-1804
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist