Provider Demographics
NPI:1639311012
Name:BUSHAW, ERICA L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:L
Last Name:BUSHAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:32 S FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2305
Mailing Address - Country:US
Mailing Address - Phone:319-283-5254
Mailing Address - Fax:319-283-5844
Practice Address - Street 1:1345 S FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-3060
Practice Address - Country:US
Practice Address - Phone:319-283-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist