=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346561727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. PAMELA JEANNE BUSH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2010
-----------------------------------------------------
Last Update Date | 06/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1477 STATE HIGHWAY 248
-----------------------------------------------------
City | BRANSON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65616-7477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-337-9529
-----------------------------------------------------
Fax | 417-334-5162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1477 STATE HIGHWAY 248
-----------------------------------------------------
City | BRANSON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65616-7477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-337-9529
-----------------------------------------------------
Fax | 417-334-5162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 044873
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 08190
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10693
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------