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General NPI Number Information
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NPI Number | 1689346512
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Entity Type | Individual
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Provider Name | JACOB WILLIAM BUSH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 401 W NORTH ST
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City | SPRINGFIELD
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State | OH
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Zip | 45504-2607
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Country | US
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Telephone | 937-324-5796
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 ASCHINGER BLVD
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City | COLUMBUS
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State | OH
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Zip | 43212-2694
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Country | US
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Telephone | 612-226-0780
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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 | 125359
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License Number State | MN
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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 | 03441089
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License Number State | OH
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