Provider Demographics
NPI:1043260375
Name:BUSAKOWSKI, ROBERT P (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:BUSAKOWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W ROSS ST
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-1749
Mailing Address - Country:US
Mailing Address - Phone:906-265-9616
Mailing Address - Fax:
Practice Address - Street 1:128 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1437
Practice Address - Country:US
Practice Address - Phone:906-265-2312
Practice Address - Fax:906-265-5608
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302022940OtherSTATE LICENSE