Healthcare Provider Details

I. General information

NPI: 1619425782
Provider Name (Legal Business Name): BENJAMIN SCOTT BUESCHER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 E JACKSON BLVD
JACKSON MO
63755-2910
US

IV. Provider business mailing address

154 TRANQUILITY TRL
JACKSON MO
63755-8600
US

V. Phone/Fax

Practice location:
  • Phone: 573-205-7360
  • Fax:
Mailing address:
  • Phone: 573-270-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016032031
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: