Provider Demographics
NPI:1245587237
Name:SLUSS, MARK V (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:V
Last Name:SLUSS
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 1:2518 DAWES ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-4744
Mailing Address - Country:US
Mailing Address - Phone:606-923-9609
Mailing Address - Fax:
Practice Address - Street 1:2201 LEXINGTON AVE
Practice Address - Street 2:KINGS DAUGHTERS HOSPITAL PHARMACY
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-0000
Practice Address - Country:US
Practice Address - Phone:606-408-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007041OtherSTATE PHARMACIST LICENSE