Provider Demographics
NPI:1093712242
Name:MCKUSICK, ANDREW PAGW (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PAGW
Last Name:MCKUSICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:6732 WINDYRUSH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7557
Mailing Address - Country:US
Mailing Address - Phone:704-543-9753
Mailing Address - Fax:704-355-4950
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:CAROLINAS MEDICAL CENTER - DEPT OF NUC MED
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-3527
Practice Address - Fax:704-355-4950
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC089901835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear