Provider Demographics
NPI:1356853964
Name:BUSHANA, ROHITH NAGA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROHITH
Middle Name:NAGA
Last Name:BUSHANA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E CAMERON AVE APT F
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7820
Mailing Address - Country:US
Mailing Address - Phone:301-646-3558
Mailing Address - Fax:
Practice Address - Street 1:262 N HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-2702
Practice Address - Country:US
Practice Address - Phone:559-562-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-04
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77775OtherPHARMACIST LICENSE