Provider Demographics
NPI:1679866347
Name:BUSH, VIVIAN E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:E
Last Name:BUSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KETCH PL
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1505
Mailing Address - Country:US
Mailing Address - Phone:706-825-1898
Mailing Address - Fax:912-966-1417
Practice Address - Street 1:516 W HWY 80
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-3108
Practice Address - Country:US
Practice Address - Phone:912-966-1416
Practice Address - Fax:912-966-1417
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist