Provider Demographics
NPI:1003258575
Name:KRUSKA, PAUL CHRISTOPHER (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CHRISTOPHER
Last Name:KRUSKA
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 1:1700 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1024
Mailing Address - Country:US
Mailing Address - Phone:989-463-0411
Mailing Address - Fax:989-463-8348
Practice Address - Street 1:1700 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1024
Practice Address - Country:US
Practice Address - Phone:989-463-0411
Practice Address - Fax:989-463-8348
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist