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General NPI Number Information
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NPI Number | 1306383559
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Entity Type | Individual
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Provider Name | MARK BUSCH RPH
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Gender | Male
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 440 WEST ST
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City | KEENE
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State | NH
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Zip | 03431-2453
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Country | US
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Telephone | 603-357-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 9 NORTHWOOD LN
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City | NEW LONDON
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State | NH
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Zip | 03257-5798
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Country | US
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Telephone | 603-526-8950
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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 | 2215
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License Number State | NH
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