Provider Demographics
NPI:1790198349
Name:KUESPERT, JOHN VICTOR (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VICTOR
Last Name:KUESPERT
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 1:8391 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3538
Mailing Address - Country:US
Mailing Address - Phone:916-383-4541
Mailing Address - Fax:
Practice Address - Street 1:8391 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3538
Practice Address - Country:US
Practice Address - Phone:916-383-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 56370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist