Provider Demographics
NPI:1962860163
Name:FINK, JUSTIN M
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:FINK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JUSTIN
Other - Middle Name:M
Other - Last Name:FINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8825 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8825 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-7644
Practice Address - Country:US
Practice Address - Phone:859-384-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013267183500000X
OH03127209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY013267OtherKENTUCKY BOARD OF PHARMACY
OH03127209OtherOHIO STATE BOARD OF PHARMACY