Healthcare Provider Details

I. General information

NPI: 1659693182
Provider Name (Legal Business Name): TASHA KAREN BUSH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 ROCKFISH VALLEY HWY
NELLYSFORD VA
22958-0726
US

IV. Provider business mailing address

PO BOX 726
NELLYSFORD VA
22958-0726
US

V. Phone/Fax

Practice location:
  • Phone: 434-361-0370
  • Fax: 434-361-0377
Mailing address:
  • Phone: 434-361-0370
  • Fax: 434-361-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202010620
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: