Provider Demographics
NPI:1275814287
Name:BUSSARD, WARREN E (RPH)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:E
Last Name:BUSSARD
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 1:1160 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3422
Mailing Address - Country:US
Mailing Address - Phone:650-347-3026
Mailing Address - Fax:
Practice Address - Street 1:1160 BROADWAY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3422
Practice Address - Country:US
Practice Address - Phone:650-347-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist