Provider Demographics
NPI:1811255144
Name:KUSHNER, ROSS ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:ALAN
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 1:4503 WHITNEY HILL CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4392
Mailing Address - Country:US
Mailing Address - Phone:502-240-0723
Mailing Address - Fax:
Practice Address - Street 1:4500 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6376
Practice Address - Country:US
Practice Address - Phone:502-493-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist