Provider Demographics
NPI:1457492084
Name:BUSH, SHANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:
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 1:5403 HEARTHSTONE LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4355
Mailing Address - Country:US
Mailing Address - Phone:615-377-4981
Mailing Address - Fax:615-641-3846
Practice Address - Street 1:3026 OWEN DR
Practice Address - Street 2:SUITE 116
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2417
Practice Address - Country:US
Practice Address - Phone:615-641-3845
Practice Address - Fax:615-641-3846
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist