Provider Demographics
NPI:1174817027
Name:BUSH, KARA LEANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LEANN
Last Name:BUSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 HIGHLANDS CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-4301
Mailing Address - Country:US
Mailing Address - Phone:276-642-6301
Mailing Address - Fax:
Practice Address - Street 1:16600 HIGHLANDS CENTER BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-4301
Practice Address - Country:US
Practice Address - Phone:276-642-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist