Provider Demographics
NPI:1346593860
Name:KUSELIAS, PETER CHARLES (PHARMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHARLES
Last Name:KUSELIAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PINEYWOODS DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3021
Mailing Address - Country:US
Mailing Address - Phone:413-427-3197
Mailing Address - Fax:
Practice Address - Street 1:2 SHAKER RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3112
Practice Address - Country:US
Practice Address - Phone:860-253-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist