Provider Demographics
NPI:1356032346
Name:GUSHEN, BRYAN WILLIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:WILLIAM
Last Name:GUSHEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1946
Mailing Address - Country:US
Mailing Address - Phone:570-205-2952
Mailing Address - Fax:
Practice Address - Street 1:50 KIRKBRIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8630
Practice Address - Country:US
Practice Address - Phone:570-271-4536
Practice Address - Fax:570-271-4537
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist