Provider Demographics
NPI:1548380397
Name:BUSBY, CASEY JOE
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JOE
Last Name:BUSBY
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 1:11146 E BIG COTTONWOOD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:UT
Mailing Address - Zip Code:84121-9778
Mailing Address - Country:US
Mailing Address - Phone:801-597-9266
Mailing Address - Fax:
Practice Address - Street 1:11146 E BIG COTTONWOOD CANYON RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:UT
Practice Address - Zip Code:84121-9778
Practice Address - Country:US
Practice Address - Phone:801-597-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3558183500000X
CA38232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist