Individual provider Active NPI

Marc Skurski, R.PH. MBA

  • Pharmacist
  • Kenosha, WI
National Provider Identifier
1912360819
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
9475-40 Issued in WI
Practice address
3535 30TH Ave
Kenosha, WI 53144-1632
Phone
(262) 658-8124
NPI assigned
Mar 30, 2016
Last updated
Mar 30, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 9475-40 WI Primary

Addresses

Primary practice location

3535 30TH Ave
Kenosha, WI 53144-1632

Mailing address

3515 100TH St
Pleasant Prairie, WI 53158-4003
Phone (262) 697-0590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Business Administration

State licenses

LicenseStateTypeSpecialty
9475-40WIMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459296000000",
    "number": "1912360819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 100TH ST",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531584003",
            "telephone_number": "262-697-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 30TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441632",
            "telephone_number": "262-658-8124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKURSKI",
        "first_name": "MARC",
        "credential": "R.PH. MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-30",
        "last_updated": "2016-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "9475-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.