Provider Demographics
NPI:1083767149
Name:KRUSCHWITZ, KENNETH L (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:KRUSCHWITZ
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 1:4200 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3956
Mailing Address - Country:US
Mailing Address - Phone:502-895-5446
Mailing Address - Fax:
Practice Address - Street 1:4200 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3956
Practice Address - Country:US
Practice Address - Phone:502-895-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY08550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist