Provider Demographics
NPI:1487137204
Name:KUSIOR, NATALIA MARIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:MARIA
Last Name:KUSIOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 N MASON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5113
Mailing Address - Country:US
Mailing Address - Phone:773-905-2187
Mailing Address - Fax:
Practice Address - Street 1:2355 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3814
Practice Address - Country:US
Practice Address - Phone:734-794-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist