Provider Demographics
NPI:1881970838
Name:BUSHEY, ROBERT IAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IAN
Last Name:BUSHEY
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 1:16619 PALM ROYAL DR APT 217
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-5002
Mailing Address - Country:US
Mailing Address - Phone:813-205-5286
Mailing Address - Fax:
Practice Address - Street 1:3890 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4800
Practice Address - Country:US
Practice Address - Phone:813-269-2814
Practice Address - Fax:813-265-4317
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist