Provider Demographics
NPI:1902263171
Name:BUSHMAN, JARED ALYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ALYN
Last Name:BUSHMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-1611
Mailing Address - Country:US
Mailing Address - Phone:660-886-9730
Mailing Address - Fax:
Practice Address - Street 1:855 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1611
Practice Address - Country:US
Practice Address - Phone:660-886-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15987183500000X
MO2017036379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist