Provider Demographics
NPI:1497244768
Name:BUSCHBOM, BEAU JASON
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:JASON
Last Name:BUSCHBOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NW ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66617-1270
Mailing Address - Country:US
Mailing Address - Phone:785-357-7397
Mailing Address - Fax:785-357-8369
Practice Address - Street 1:2600 NW ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66617-1270
Practice Address - Country:US
Practice Address - Phone:785-357-7397
Practice Address - Fax:785-357-8369
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist