Provider Demographics
NPI:1346561727
Name:BUSH, PAMELA JEANNE
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEANNE
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 STATE HIGHWAY 248
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7477
Mailing Address - Country:US
Mailing Address - Phone:417-337-9529
Mailing Address - Fax:417-334-5162
Practice Address - Street 1:1477 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7477
Practice Address - Country:US
Practice Address - Phone:417-337-9529
Practice Address - Fax:417-334-5162
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044873183500000X
AR08190183500000X
CO10693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist