Provider Demographics
NPI:1184706137
Name:KUZNER, PAUL G (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:G
Last Name:KUZNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52757 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2078
Mailing Address - Country:US
Mailing Address - Phone:586-739-3004
Mailing Address - Fax:586-263-4455
Practice Address - Street 1:16828 21 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2601
Practice Address - Country:US
Practice Address - Phone:586-263-9100
Practice Address - Fax:586-263-4455
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302411137OtherPHARMACIST LICENSE NUMBER