Provider Demographics
NPI:1750846150
Name:BUSH, DAVID EDWARD
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:BUSH
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 1:1588 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1060
Mailing Address - Country:US
Mailing Address - Phone:317-462-7877
Mailing Address - Fax:317-467-8732
Practice Address - Street 1:1588 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1060
Practice Address - Country:US
Practice Address - Phone:317-462-7877
Practice Address - Fax:317-467-8732
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist