Provider Demographics
NPI:1083695811
Name:RUSCIN, JOHN MARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:RUSCIN
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 1:805 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2805
Mailing Address - Country:US
Mailing Address - Phone:217-753-3895
Mailing Address - Fax:
Practice Address - Street 1:701 N. FIRST STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62794-9636
Practice Address - Country:US
Practice Address - Phone:217-545-3934
Practice Address - Fax:217-545-7127
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO146451835P1200X
IL0510394361835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy