Provider Demographics
NPI:1013510197
Name:KOUSIN, BRIANNA N (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:N
Last Name:KOUSIN
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 1:3007 CLINTON AVE UNIT 316
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3173
Mailing Address - Country:US
Mailing Address - Phone:845-662-1262
Mailing Address - Fax:
Practice Address - Street 1:14440 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3329
Practice Address - Country:US
Practice Address - Phone:216-381-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist