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General NPI Number Information
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NPI Number | 1144742610
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Entity Type | Individual
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Provider Name | MICHAEL LEE BUSS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2017
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Last Update Date | 07/16/2017
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Provider Practice Location Address
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Address Line | 53 S MAPLE ST
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City | GRANT
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State | MI
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Zip | 49327-8426
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Country | US
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Telephone | 231-834-5744
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Fax | 231-834-9280
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Provider Business Mailing Address
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Address Line | 1111 DICK AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-3915
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Country | US
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Telephone | 231-388-2823
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302041909
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License Number State | MI
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