Provider Demographics
NPI:1164416921
Name:BUSENBARK, LAURA ANN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:BUSENBARK
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 1:495 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3724
Mailing Address - Country:US
Mailing Address - Phone:931-526-9723
Mailing Address - Fax:931-372-2617
Practice Address - Street 1:495 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3724
Practice Address - Country:US
Practice Address - Phone:931-526-9723
Practice Address - Fax:931-372-2617
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40346183500000X
TN00033912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist