Provider Demographics
NPI:1285641761
Name:PRUSKI, CASIMER JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:CASIMER
Middle Name:JOSEPH
Last Name:PRUSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CASIMER
Other - Middle Name:JOSEPH
Other - Last Name:PRUSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:13729 ALBION EAGLE HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9125
Mailing Address - Country:US
Mailing Address - Phone:585-297-1100
Mailing Address - Fax:
Practice Address - Street 1:220 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1227
Practice Address - Country:US
Practice Address - Phone:585-297-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist