Provider Demographics
NPI:1790380269
Name:BUSHMAN, DEBORAH LEE (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:BUSHMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1217
Mailing Address - Country:US
Mailing Address - Phone:765-935-4650
Mailing Address - Fax:
Practice Address - Street 1:2150 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1217
Practice Address - Country:US
Practice Address - Phone:765-935-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014704A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist