Provider Demographics
NPI:1609208420
Name:VANBUSKIRK, KATIE LYNN (PHARM D)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 MULLANPHY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4213
Mailing Address - Country:US
Mailing Address - Phone:314-749-8578
Mailing Address - Fax:
Practice Address - Street 1:3425 BREMEN HWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-6511
Practice Address - Country:US
Practice Address - Phone:574-257-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025083A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist