Bruce Boushon, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

12756 Issued in WI

Practice address

142 E St Hwy 260
Payson, AZ 85541-4948

Phone

(928) 474-7039

Fax

(928) 474-3415

NPI assigned

Jun 12, 2006

Last updated

Dec 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1003858218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 E ST HWY 260",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855414948",
            "telephone_number": "928-474-7039",
            "fax_number": "928-474-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 E ST HWY 260",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855414948",
            "telephone_number": "928-474-7039",
            "fax_number": "928-474-3415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "825 W Fulton St",
            "address_purpose": "LOCATION",
            "city": "Waupaca",
            "state": "WI",
            "postal_code": "549811471",
            "country_code": "US",
            "telephone_number": "715-258-9000",
            "fax_number": "715-258-4119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUSHON",
        "first_name": "BRUCE",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "12756",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S021084",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Payson, AZ
• Providers in Payson, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.