Provider Demographics
NPI:1750664173
Name:MUSHLOCK, DUSTIN JOSEPH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:JOSEPH
Last Name:MUSHLOCK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9307
Mailing Address - Country:US
Mailing Address - Phone:231-348-7510
Mailing Address - Fax:
Practice Address - Street 1:1301 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9307
Practice Address - Country:US
Practice Address - Phone:231-348-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist