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General NPI Number Information
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NPI Number | 1407442817
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Entity Type | Individual
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Provider Name | BLAKE BUSCH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2020
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Last Update Date | 12/19/2020
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Provider Practice Location Address
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Address Line | 8450 EAGER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63144-1413
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Country | US
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Telephone | 314-962-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 5770 WICKERSHIRE LN
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City | SAINT LOUIS
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State | MO
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Zip | 63129-7236
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Country | US
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Telephone | 314-445-9615
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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 | 051303232
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2019025919
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License Number State | MO
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