Provider Demographics
NPI:1538470687
Name:FURBUSH, JASON KEITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:KEITH
Last Name:FURBUSH
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 1:106 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7700
Mailing Address - Country:US
Mailing Address - Phone:360-458-8467
Mailing Address - Fax:
Practice Address - Street 1:106 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7700
Practice Address - Country:US
Practice Address - Phone:360-458-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60148537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist