Provider Demographics
NPI:1053399808
Name:COUSINO, DAVID (RPH, CGP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COUSINO
Suffix:
Gender:M
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2816
Mailing Address - Country:US
Mailing Address - Phone:440-628-5072
Mailing Address - Fax:216-937-0368
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:SUITE #203
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:440-832-7379
Practice Address - Fax:216-937-0368
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221271183500000X
PARP438933183500000X
OH02961835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric