Healthcare Provider Details

I. General information

NPI: 1447938642
Provider Name (Legal Business Name): VICTORIA WARE BUSH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE # 119
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

116 N PAULINE ST
MEMPHIS TN
38104-1005
US

V. Phone/Fax

Practice location:
  • Phone: 901-577-7217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number47226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: