Healthcare Provider Details

I. General information

NPI: 1285457978
Provider Name (Legal Business Name): GUSOON MHESIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 PARK PLAZA AVE UNIT 104
LOUISVILLE KY
40241-2289
US

IV. Provider business mailing address

9720 PARK PLAZA AVE UNIT 104
LOUISVILLE KY
40241-2289
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-8218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number019063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: