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1689346512 NPI number — JACOB WILLIAM BUSH PHARMD

NPI Number: 1689346512
Health Care Provider/Practitioner: JACOB WILLIAM BUSH PHARMD

Information about “1689346512” NPI (JACOB WILLIAM BUSH PHARMD) exists in 1689346512 in HTML format HTML  |  1689346512 in plain Text format TXT  |  1689346512 in PDF (Portable Document Format) PDF  |  1689346512 in an XML format XML  formats.

NPI Number : 1689346512 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689346512",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUSH",
    "FirstName": "JACOB",
    "MiddleName": "WILLIAM",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1708 ASCHINGER BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBUS",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "43212-2694",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "612-226-0780",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "401 W NORTH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPRINGFIELD",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45504-2607",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "937-324-5796",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/29/2021",
    "LastUpdateDate": "09/29/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "125359",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "03441089",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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