Provider Demographics
NPI:1982983730
Name:PUSTULKA, JOHN JACOB (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JACOB
Last Name:PUSTULKA
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 1:801 INVERNESS AVE
Mailing Address - Street 2:APT. A-13
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2735
Mailing Address - Country:US
Mailing Address - Phone:313-408-6723
Mailing Address - Fax:
Practice Address - Street 1:1301 BELL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3730
Practice Address - Country:US
Practice Address - Phone:615-837-6990
Practice Address - Fax:615-837-9759
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist