Provider Demographics
NPI:1366853905
Name:KUSHMAN, STACY ANN (BS PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:KUSHMAN
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 ASCOT DR
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9146
Mailing Address - Country:US
Mailing Address - Phone:513-543-2015
Mailing Address - Fax:
Practice Address - Street 1:1082 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-4933
Practice Address - Country:US
Practice Address - Phone:513-576-5533
Practice Address - Fax:513-576-5565
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031242771835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy