Provider Demographics
NPI:1811227747
Name:KAUSHANSKY, ALEX (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:KAUSHANSKY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19212 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6268
Mailing Address - Country:US
Mailing Address - Phone:425-774-5867
Mailing Address - Fax:
Practice Address - Street 1:17524 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4813
Practice Address - Country:US
Practice Address - Phone:206-542-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00055269183500000X
AK1863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist