Healthcare Provider Details

I. General information

NPI: 1275357428
Provider Name (Legal Business Name): DR. CULLEN A KUTSCHEROUSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S LOOP 340
ROBINSON TX
76706-4828
US

IV. Provider business mailing address

3600 S LOOP 340
ROBINSON TX
76706-4828
US

V. Phone/Fax

Practice location:
  • Phone: 254-523-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: