Profile - PHA
Profile - PHA
General Disclaimer:
The information posted on the Healthcare Professions Profile Program (HPPP) website was provided by applicants for an original license; applicants for reinstatement or reactivation of an existing license; as well as by those individuals renewing a license. While the Division believes the information to be reliable, human or mechanical error remains a possibility, as does the delay in the posting or updating of information. The Division makes no guarantee as to the accuracy or completeness of the information and the information is not verified by the HPPP staff. The Division will take action to obtain compliance with the requirements to provide accurate and timely information as required by law when information is received that indicates information required by law has not been provided or is not accurate.

Availability Disclaimer:
Healthcare professionals who have an inactive or lapsed license are not required to complete a Healthcare Professions Profile until they apply for reactivation or reinstatement. If you have questions about a missing Healthcare Professions Profile or any missing documents that should be listed, please contact the Healthcare Professions Profile Program at dora_dpo_hppp@state.co.us or 303-894-5942.

Malpractice Claims Disclaimer: Some studies have shown that there is no significant correlation between malpractice history and a healthcare professional's competence. At the same time, consumers should have access to malpractice information. To make the best healthcare decisions, you should view this information in perspective. You could miss an opportunity for high quality care by selecting a healthcare professional based solely on malpractice history. When considering malpractice data, please keep in mind: Malpractice histories tend to vary by profession and by specialty. Some professions or specialties are more likely than others to be the subject of litigation. You should take into account how long the healthcare professional has been in practice when considering malpractice averages. The incident causing the malpractice claim may have happened years before a payment is finally made. Sometimes, it takes a long time for a malpractice lawsuit to move through the legal system. Some healthcare professionals work primarily with high-risk patients. These healthcare professionals may have malpractice histories that are higher than average because they specialize in cases or patients who are at very high risk for problems. Settlement of a claim may occur for a variety of reasons that do not necessarily reflect negatively on the professional competence or conduct of the healthcare professional. A payment in settlement of a malpractice action or claim should not be construed as creating a presumption that malpractice has occurred. You may wish to discuss information provided, and malpractice generally, with your healthcare professional.
Name John E Srutowski
Credential PHA

HPPP - PHA Introduction

Healthcare Professions Profile
Please be aware that this profile is only for your Pharmacist license. Do not provide information for other license types you hold on this profile. You will be required to complete a profile for every license you hold that is included in the profiling requirement.

All information provided in this profile must be updated within 30 days of any change of information unless your profession's statute says otherwise, or unless the question specifies otherwise.

 

HPPP - PHA Location of Practice

Location of Practice
1.  Are you currently practicing in the healthcare profession associated with this profile?
Yes
 

HPPP GLOBAL - Location of Practice If Yes

Location of Practice
2.  Practice Locations:
Address  City  State  Zip Code  Phone Number 
1501 W Chisholm St
Alpena
 Michigan
 49707
 9893567000
500 S. Oakwood Rd
 Oshkosh
 Wisconsin
 54904
 800-367-5690 x11815
 

HPPP - PHA Education and Training

Education and Training
3.  Education Level:
Masters Degree
 
 

HPPP - PHA Other Licenses

Other Licenses
5.  Have you ever held, or do you currently hold any other licenses in this profession from any other state, country or province?
Yes
 

HPPP GLOBAL - Other Licenses if Yes

Other Licenses
6.  Other Licenses:
State  License Status  Year Originally Issued 
Michigan
 Active
 1990
Wisconsin
 Active
 2013
 

HPPP - PHA Board Certifications

Board Certifications
7.  Do you hold any current Board Certifications?
No
 

HPPP - PHA Board Certifications if Yes

Board Certifications
8.  Board Certifications:

 

HPPP - PHA Practice Specialties

Practice Specialties
9.  Do you have a practice specialty in which you are appropriately trained and actively practicing?
No
 

HPPP - PHA Practice Specialties if yes

Practice Specialties
10.  Practice Specialties:

 

HPPP - PHA CO Hospital Affiliations

Colorado Hospital Affiliations
11.  Do you have a current affiliation or clinical privileges with any Colorado Hospital?
No
 

HPPP GLOBAL - CO Hospital Affiliations if Yes

Colorado Hospital Affiliations
12.  Colorado Hospital Affiliations:
Hospital  Affiliation Type  City 
 

HPPP - PHA Other Hospital Affiliations

Other Health Care Facilities and Out of State Hospital Affiliations
13.  Do you have a current affiliation with any healthcare facility or a non-Colorado hospital?
Yes
 

HPPP GLOBAL - Other Hospital Affiliations If Yes

Other Health Care Facilities and Out of State Hospital Affiliations
14.  Other Healthcare Facility Affiliations:
Facility  Affiliation Type  City  State 
Select Specialty Hospital - Administrative
Other
 Denver
 Colorado
 

HPPP - PHA Business Ownership

Business Ownership
15.  Do you have a current business ownership interest in any healthcare-related business?
No
 

HPPP GLOBAL - Business Ownership if Yes

Business Ownership
16.  Business Ownership:
Business Name  City  State 
 

HPPP - PHA Employer

Employer
17.  Do you have an employer in the profession in which you are licensed or are applying for a license?
Yes
 

HPPP GLOBAL - Employer if Yes

Employer
18.  Employer:
Employer Name  Address  City  State  Zip Code  Phone Number 
Select Medical
 4714 Gettysburg Road
 Mechanicsburg
 Pennsylvania
 17055
 (888) 735-6332
 

HPPP - PHA Employment Contracts

Employment Contracts
19.  Do you have a contract with any business whose mission relates to healthcare services or products where the value is greater than $5000 annually?
No
 

HPPP GLOBAL - Employment Contracts if Yes

Employment Contracts
20.  Employment Contracts:
Entity Name  Length of Contract  Contract Position 
 

HPPP - PHA Disciplinary Actions

Disciplinary Actions
21.  Have you ever had public disciplinary action taken against your license by any board or licensing agency in any state or country?
No
 

HPPP GLOBAL - Disciplinary Actions if Yes

Disciplinary Actions
22.  Disciplinary Actions:
Discipline Year  State 
 

HPPP - PHA Restrictions and Suspensions

Restrictions and Suspensions
23.  Have you ever entered into any agreement or stipulation to temporarily cease your practice or had a board order issued restricting or suspending your license?
No
 

HPPP GLOBAL - Restrictions and Suspensions if Yes

Restrictions and Suspensions
24.  Restrictions and Suspensions:
Restriction Year  State 
 

HPPP - PHA Healthcare Facility Actions

Healthcare Facility Actions
25.  Since September 1, 1990, have you had any final actions resulting in involuntary limitations or probationary status on or reduction, nonrenewal, denial, revocation or suspension of medical staff membership or clinical privileges at a hospital or healthcare facility? You are not required to report a precautionary or administrative suspension unless you resigned your medical staff membership or clinical privileges while the suspension was pending.
No
 

HPPP GLOBAL - Healthcare Facility Actions if Yes

Healthcare Facility Actions
26.  Healthcare Facility Actions:
Facility Name  City  State  Type of Action  Year of Action  Duration  Terms Complete 
 

HPPP - PHA Termination of Employment

Termination of Employment
27.  Have you ever been terminated by an employer for a reason that would be considered a violation of your profession's practice law?
No
 

HPPP GLOBAL - Termination of Employment if Yes

Termination of Employment
28.  Terminations:
Employer Name  Termination Date 
 

HPPP - PHA Convictions

Convictions
29.  Since you were issued a license to practice your profession in any state or country, have you had any final criminal conviction(s) or plea arrangement(s) resulting from the commission or alleged commission of a felony or crime of moral turpitude in any jurisdiction?
No
 

HPPP GLOBAL - Convictions if Yes

Convictions
30.  Convictions:
Year  State  Jurisdiction 
 

HPPP - PHA Malpractice Claims

Malpractice Claims
31.  Since September 1, 1990, have you had any final judgment, entered into a settlement, or paid an arbitration award for malpractice?
No
 

HPPP GLOBAL - Malpractice Claims if Yes

Malpractice Claims
32.  Malpractice Claims:
Year  State  Claim Type  Name 
 

HPPP - PHA Malpractice Carrier Refusal

Malpractice Carrier Refusal
33.  Have you been denied liability insurance, or has your liability insurance coverage been limited, restricted or terminated by the insurance carrier?
No
 

HPPP GLOBAL - Malpractice Carrier Refusal if Yes

Malpractice Carrier Refusal
34.  Malpractice Carrier Refusal:
Carrier Refusal Year 
 

HPPP - PHA Optional Narrative

Optional Narrative
35.  Optional Narrative:

 

HPPP - PHA Attestation

Attestation
By submitting this Healthcare Professions Profile to the Division of Professions and Occupations you are attesting that:
  • You are the person identified in this profile; or
  • You are authorized to submit information on behalf of the person identified in this profile; and
  • The information contained herein is true and correct to the best of my knowledge.
 
36.  Submission Date:
11/05/2014
 

Review
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