Provider Demographics
NPI:1295061711
Name:BUSHO, AMANDA A (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:BUSHO
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 1:2130 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7408
Mailing Address - Country:US
Mailing Address - Phone:910-343-2988
Mailing Address - Fax:910-343-2950
Practice Address - Street 1:2130 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7408
Practice Address - Country:US
Practice Address - Phone:910-343-2988
Practice Address - Fax:910-343-2950
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist