Provider Demographics
NPI:1568694446
Name:BUSS, EVELYN JEANETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:JEANETTE
Last Name:BUSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N US HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-9344
Mailing Address - Country:US
Mailing Address - Phone:608-635-9456
Mailing Address - Fax:608-635-9458
Practice Address - Street 1:317 N US HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-9344
Practice Address - Country:US
Practice Address - Phone:608-635-9456
Practice Address - Fax:608-635-9458
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12438-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist