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General NPI Number Information
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NPI Number | 1558970046
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Entity Type | Individual
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Provider Name | EMILY MICHELLE BUSH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 3502 E GRAND FOREST DR APT 104
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City | BOISE
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State | ID
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Zip | 83716-5854
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Country | US
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Telephone | 904-412-8034
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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 | P8961
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License Number State | ID
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