Provider Demographics
NPI:1538362587
Name:BUSH, ROBERT EDGAR (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDGAR
Last Name:BUSH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 COUNTY ROAD 4550
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-8586
Mailing Address - Country:US
Mailing Address - Phone:903-572-4159
Mailing Address - Fax:
Practice Address - Street 1:609 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3646
Practice Address - Country:US
Practice Address - Phone:903-572-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist