Provider Demographics
NPI:1902350093
Name:BUSCEMI, JORDAN V (PHARMACY STUDENT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:V
Last Name:BUSCEMI
Suffix:
Gender:M
Credentials:PHARMACY STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 COLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9301
Mailing Address - Country:US
Mailing Address - Phone:586-419-9898
Mailing Address - Fax:
Practice Address - Street 1:3141 COLSTREAM DR
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-9301
Practice Address - Country:US
Practice Address - Phone:586-419-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist