Provider Demographics
NPI:1609038926
Name:BUSCH PHARMACY LLC
Entity Type:Organization
Organization Name:BUSCH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIRAV (NICK)
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-784-3085
Mailing Address - Street 1:6751 N ARMENIA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5771
Mailing Address - Country:US
Mailing Address - Phone:813-990-8300
Mailing Address - Fax:813-990-8380
Practice Address - Street 1:6751 N ARMENIA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5771
Practice Address - Country:US
Practice Address - Phone:813-990-8300
Practice Address - Fax:813-990-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH234583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6729420001Medicare NSC