Provider Demographics
NPI:1669863122
Name:BUSH, BENJAMIN ANDREW (CPT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ANDREW
Last Name:BUSH
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1056
Mailing Address - Country:US
Mailing Address - Phone:607-257-0291
Mailing Address - Fax:607-216-6261
Practice Address - Street 1:40 CATHERWOOD RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1056
Practice Address - Country:US
Practice Address - Phone:607-257-0291
Practice Address - Fax:607-216-6261
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician