Healthcare Provider Details

I. General information

NPI: 1689046385
Provider Name (Legal Business Name): ADAM LUKE KUZMESKUS PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 MEMORIAL DR
ST JOHNSBURY VT
05819-9238
US

IV. Provider business mailing address

957 MEMORIAL DR
ST JOHNSBURY VT
05819-9238
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-2778
  • Fax: 802-748-1452
Mailing address:
  • Phone: 802-748-2778
  • Fax: 802-748-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0003612
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: