Provider Demographics
NPI:1891908281
Name:BUSROE, NANCY KATHRYN (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KATHRYN
Last Name:BUSROE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1144
Mailing Address - Country:US
Mailing Address - Phone:606-780-0565
Mailing Address - Fax:
Practice Address - Street 1:SPINDLETOP ADMINISTRATION BLDG
Practice Address - Street 2:2624 RESEARCH PARK DRIVE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511
Practice Address - Country:US
Practice Address - Phone:859-246-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist