Provider Demographics
NPI:1700417599
Name:WALKUSKI, MARK A JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:WALKUSKI
Suffix:JR
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 1:27365 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1200
Mailing Address - Country:US
Mailing Address - Phone:313-274-6240
Mailing Address - Fax:313-274-7245
Practice Address - Street 1:27365 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1200
Practice Address - Country:US
Practice Address - Phone:313-274-6240
Practice Address - Fax:313-274-7245
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist