1588656490 NPI number — DR. MARK STEPHEN MCCUISTON PHARM.D.

Table of content: DR. MARK STEPHEN MCCUISTON PHARM.D. (NPI 1588656490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588656490 NPI number — DR. MARK STEPHEN MCCUISTON PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCUISTON
Provider First Name:
MARK
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588656490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 PENSACOLA BEACH BLVD
Provider Second Line Business Mailing Address:
12B
Provider Business Mailing Address City Name:
PENSACOLA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32561-2079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-932-5152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 GULF BREEZE PKWY
Provider Second Line Business Practice Location Address:
SUITE 200 MOB
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32561-4884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-934-2170
Provider Business Practice Location Address Fax Number:
850-934-2039
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS31721 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com