MEDICARE: MR. MARK V. SLUSS R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	007041	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	007041	OTHER	KY	STATE PHARMACIST LICENSE

General Provider Information

NPI Number	:	1245587237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK V. SLUSS R.PH.

Provider Business Mailing Address
First Line	:	2518 DAWES ST
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41102-4744
Country	:	US
Telephone Number	:	606-923-9609
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 LEXINGTON AVE
Second Line	:	KINGS DAUGHTERS HOSPITAL PHARMACY
City	:	ASHLAND
State	:	KY
Zip	:	41101-0000
Country	:	US
Telephone Number	:	606-408-4641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	08/08/2012

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