Provider Demographics
NPI:1669847323
Name:KASABUSKI, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KASABUSKI
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 1:49 JUNIPER DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:ASHAWAY
Mailing Address - State:RI
Mailing Address - Zip Code:02804-1905
Mailing Address - Country:US
Mailing Address - Phone:401-447-9019
Mailing Address - Fax:
Practice Address - Street 1:195 RIVER RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351-3253
Practice Address - Country:US
Practice Address - Phone:860-823-2961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0010798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist