Provider Demographics
NPI:1700404670
Name:KUSOVSCHI, ABEL E (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:E
Last Name:KUSOVSCHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 LANCELOT WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4756
Mailing Address - Country:US
Mailing Address - Phone:678-779-9424
Mailing Address - Fax:
Practice Address - Street 1:146 LANCELOT WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4756
Practice Address - Country:US
Practice Address - Phone:678-779-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist