Provider Demographics
NPI:1821380445
Name:LUSHER, CHARLES D
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:LUSHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PIATT AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1515
Mailing Address - Country:US
Mailing Address - Phone:740-772-5874
Mailing Address - Fax:
Practice Address - Street 1:344 PIATT AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1515
Practice Address - Country:US
Practice Address - Phone:740-772-5874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03210009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
18OtherTAXONOMY