Provider Demographics
NPI:1801497391
Name:KUKURA, RICHARD MICHAEL JR (PHARMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:KUKURA
Suffix:JR
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 1:71 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1277
Mailing Address - Country:US
Mailing Address - Phone:330-261-7702
Mailing Address - Fax:
Practice Address - Street 1:2700 W STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5611
Practice Address - Country:US
Practice Address - Phone:330-821-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist