Provider Demographics
NPI:1770125015
Name:BUSH, NATHAN MARTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MARTIN
Last Name:BUSH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 FORSYTH RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9654
Mailing Address - Country:US
Mailing Address - Phone:814-603-0299
Mailing Address - Fax:
Practice Address - Street 1:30 W PARK AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2452
Practice Address - Country:US
Practice Address - Phone:814-371-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist