Provider Demographics
NPI:1811594419
Name:KUSHNER, DINA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:MARIE
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CASTINE RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:PA
Mailing Address - Zip Code:15942-5604
Mailing Address - Country:US
Mailing Address - Phone:814-421-8490
Mailing Address - Fax:
Practice Address - Street 1:1932 WILLIAM PENN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-1637
Practice Address - Country:US
Practice Address - Phone:814-322-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP451579OtherCOMMONWEALTH OF PENNSYLVANIA STATE BOARD OF PHARMACY
PARPI011504OtherCOMMONWEALTH OF PENNSYLVANIA STATE BOARD OF PHARMACY