MEDICARE: DR. DAVID RAY RUSH PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	029986	MO

General Provider Information

NPI Number	:	1982768867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RAY RUSH PHARM.D.

Provider Business Mailing Address
First Line	:	17074 S DEMI DR
Second Line	:
City	:	VILLAGE OF LOCH LLOYD
State	:	MO
Zip	:	64012-4117
Country	:	US
Telephone Number	:	816-322-1502
Fax Number	:	816-322-1026

Provider Business Practice Location Address
First Line	:	17074 S DEMI DR
Second Line	:
City	:	VILLAGE OF LOCH LLOYD
State	:	MO
Zip	:	64012-4117
Country	:	US
Telephone Number	:	816-322-1502
Fax Number	:	816-322-1026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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