Provider Demographics
NPI:1437759040
Name:KUSH, EDWARD JOHN
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:KUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20245 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6101
Mailing Address - Country:US
Mailing Address - Phone:724-772-4553
Mailing Address - Fax:724-772-4555
Practice Address - Street 1:20245 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6101
Practice Address - Country:US
Practice Address - Phone:724-772-4553
Practice Address - Fax:724-772-4555
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044196L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist