Provider Demographics
NPI:1144793357
Name:BUSHLAND DRUG, LLC
Entity Type:Organization
Organization Name:BUSHLAND DRUG, LLC
Other - Org Name:BUSHLAND DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEFFREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-310-9853
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:BUSHLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79012-0016
Mailing Address - Country:US
Mailing Address - Phone:806-310-9853
Mailing Address - Fax:806-310-9854
Practice Address - Street 1:1600 S. FM 2381
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124
Practice Address - Country:US
Practice Address - Phone:806-310-9853
Practice Address - Fax:806-310-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy