Provider Demographics
NPI:1235206913
Name:HUSHIN, MICHAEL T (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:HUSHIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:130 ROCKAWAY ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1019
Mailing Address - Country:US
Mailing Address - Phone:631-277-4814
Mailing Address - Fax:631-588-5932
Practice Address - Street 1:886 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6058
Practice Address - Country:US
Practice Address - Phone:631-588-6330
Practice Address - Fax:631-588-5932
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist