Provider Demographics
NPI:1093039422
Name:BUSH, KATIE ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:BUSH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 MCCREA BRK
Mailing Address - Street 2:
Mailing Address - City:ELDRED
Mailing Address - State:PA
Mailing Address - Zip Code:16731-5224
Mailing Address - Country:US
Mailing Address - Phone:716-397-9224
Mailing Address - Fax:
Practice Address - Street 1:415 N UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2617
Practice Address - Country:US
Practice Address - Phone:716-372-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-13
Last Update Date:2010-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20054291183500000X
PARP444329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist