Provider Demographics
NPI:1881984615
Name:FUSSENEGGER, BERNARD JOSEPH SR
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:JOSEPH
Last Name:FUSSENEGGER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8651 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-5305
Mailing Address - Country:US
Mailing Address - Phone:502-969-1309
Mailing Address - Fax:502-969-7266
Practice Address - Street 1:8651 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5305
Practice Address - Country:US
Practice Address - Phone:502-969-1309
Practice Address - Fax:502-969-7266
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist