Provider Demographics
NPI:1396021218
Name:BUSH, JADA RASHON (PHARMD)
Entity type:Individual
Prefix:MS
First Name:JADA
Middle Name:RASHON
Last Name:BUSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S WILLIAM ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2515
Mailing Address - Country:US
Mailing Address - Phone:574-472-7881
Mailing Address - Fax:574-586-5257
Practice Address - Street 1:201 S WILLIAM ST STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2515
Practice Address - Country:US
Practice Address - Phone:574-472-7881
Practice Address - Fax:574-586-5257
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021412A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist