Provider Demographics
NPI:1578909578
Name:BUSHEE, DAVID ALAN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:BUSHEE
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 1:1306 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1507
Mailing Address - Country:US
Mailing Address - Phone:715-387-3705
Mailing Address - Fax:
Practice Address - Street 1:1306 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1507
Practice Address - Country:US
Practice Address - Phone:715-387-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist