MR. KENNETH BRADLEY BUSH II (NPI# 1093354649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093354649 |
| Entity Type | Individual |
| Full Name | MR. KENNETH BRADLEY BUSH II |
| Credential | RPH |
| Practice Address |
3095 Goodman Rd E Southaven MS 38672-8707 |
| Mailing Address |
3588 Edgewood Blvd W Hernando MS 38632-9383 |
| Practice Telephone | 6625363743 |
| Mailing Telephone | 9018968910 |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2020-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
E-8208 | MS | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497084578 | Kenneth Aaron Bush | Physical Therapist | 725 Wilcox St, Castle Rock, CO 80104-1740 | 2009-12-18 |
| 1992002935 | Kenneth Michael Bush | Pharmacist | 21000 E 12 Mile Rd, Ste 124, Saint Clair Shores, MI 48081-1116 | 2011-02-25 |
| 1528020682 | Kenneth W. Bush | Physician Assistant | 2311 Lewisville Clemmons Rd, Clemmons, NC 27012-8905 | 2006-04-04 |
| Street Address |
3095 GOODMAN RD E |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38672-8707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386678167 | Kroger Limited Partnership I | Durable Medical Equipment & Medical Supplies | 3095 Goodman Rd E, Southaven, MS 38672-8707 | 2006-07-10 |
| 1801433859 | Christopher Brunson | Pharmacist | 3095 Goodman Rd E, Southaven, MS 38672-8707 | 2019-12-09 |
| 1902443963 | Jason Sesti | Pharmacist | 3095 Goodman Rd E, Southaven, MS 38672-8707 | 2019-12-09 |
| 1821398025 | Alicia G Sims | Pharmacist | 3095 Goodman Rd E, Southaven, MS 38672-8707 | 2010-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871100826 | Sarah Kathryn Pratt | Physical Therapist | 5271 Getwell Road, Suite A, Southaven, MS 38672 | 2020-09-24 |
| 1356713606 | Deadra Dennis | Behavioral Analyst | 2816 Calico Rock Cv, Southaven, MS 38672 | 2015-10-27 |
| 1568727352 | Patricia Leanne Lewis | Family Medicine | 5908 Getwell Rd, Southaven, MS 38672 | 2012-07-09 |
| 1417183922 | Mississippi Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 2945 Goodman Road East, Southaven, MS 38672 | 2009-06-10 |
| 1568609998 | Susan Orsland | Physical Therapist | 4355 Genevieve Drive, Southaven, MS 38672 | 2009-01-07 |
| 1659516524 | Stacy L Sanders | Audiologist | 5740 Getwell Rd. Building 3 Unit B, Southaven, MS 38672 | 2008-12-08 |
| 1295927226 | Tracey F Petrides | Family Medicine | 5779 Getwell Road, Building D, Suite 3, Southaven, MS 38672 | 2007-08-14 |
| 1538288741 | Bruce A Denney | Dentist | 7125 Getwell Road, Suite 102, Southaven, MS 38672 | 2007-03-28 |
| 1154480150 | Kimberly Marie Metcalf | Social Worker | 7165-g Getwell Rd., Southaven, MS 38672 | 2006-12-06 |
| 1346318441 | Deborah Verucchi | Nurse Practitioner | 5740 Getwell Rd Ste B, Southaven, MS 38672 | 2006-11-30 |
| Find all providers in zip 38672 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467085274 | Kenneth Martin | Pharmacist | 1811 West Govt St, Brandon, MS 39042-2106 | 2020-02-20 |
| 1316585581 | Deborah Magoun Rosenbaum | Pharmacist | [email protected], 4910 I-55 North, Jackson, MS 39211 | 2019-12-18 |
| 1326686932 | Joshua Brett Manning | Pharmacist | Kroger, 2340 Highway 15 N, Laurel, MS 39440-1831 | 2019-12-13 |
| 1023585296 | Brenda M Wise | Pharmacist | 301 Fisher St # 2b, Biloxi, MS 39534-2508 | 2018-10-25 |
| 1508311028 | Koshy Mathew | Pharmacist | 122 Mcdill Cv, Madison, MS 39110-6562 | 2016-08-25 |
| 1992106413 | Roland Mullins Jr. | Pharmacist | 301 Fisher St Rm 309b, Keesler Afb, MS 39534-2508 | 2014-09-16 |
| 1124432679 | Tara Lynn Felder | Pharmacist | 1121 Hwy 98/51, Summit, MS 39666 | 2014-06-12 |
| 1912333956 | Carman G Cochran | Pharmacist | 68 Buffalo Rd, Mc Lain, MS 39456-2330 | 2013-09-23 |
| 1902239197 | Melanie Hammill Bishop | Pharmacist | 427 Ms Highway 51 North, Brookhaven, MS 39601 | 2013-08-12 |
| 1578833299 | April Malone | Pharmacist | 208 S 27th Ave, Hattiesburg, MS 39401-7173 | 2012-01-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.