Provider Demographics
NPI:1386208775
Name:HRUSKA, KENNETH PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:PAUL
Last Name:HRUSKA
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 1:1680 COUNTY ROAD 492
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9634
Mailing Address - Country:US
Mailing Address - Phone:906-225-3902
Mailing Address - Fax:906-226-2661
Practice Address - Street 1:1680 COUNTY ROAD 492
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9634
Practice Address - Country:US
Practice Address - Phone:906-225-3902
Practice Address - Fax:906-226-2661
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist