Provider Demographics
NPI:1669580007
Name:BUSSIS, JAMES LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:BUSSIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9539
Mailing Address - Country:US
Mailing Address - Phone:269-751-8843
Mailing Address - Fax:
Practice Address - Street 1:803 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5306
Practice Address - Country:US
Practice Address - Phone:616-396-5233
Practice Address - Fax:616-396-4270
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist