Provider Demographics
NPI:1659372563
Name:KUSCH, CAROLYN (RPH)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:KUSCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 PEYTON DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4425
Mailing Address - Country:US
Mailing Address - Phone:734-482-1590
Mailing Address - Fax:
Practice Address - Street 1:2020 GREEN RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2553
Practice Address - Country:US
Practice Address - Phone:734-994-7246
Practice Address - Fax:734-994-0638
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist