Kenneth Bradley Bush II, RPH

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

E-8208 Issued in MS

Practice address

3095 Goodman Rd E
Southaven, MS 38672-8707

Phone

(662) 536-3743

NPI assigned

Dec 31, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kroger Limited Partnership I

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Southaven, MS
  • NPI 1386678167
  NPD
• Kroger Limited Partnership I

  dba Kroger Pharmacy #473

  • Community/Retail Pharmacy
  • Newport, KY
  • NPI 1104791078
  NPD (past)

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

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1093354649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3588 EDGEWOOD BLVD W",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386329383",
            "telephone_number": "901-896-8910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386728707",
            "telephone_number": "662-536-3743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "KENNETH",
        "middle_name": "BRADLEY",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-31",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "MS",
            "license": "E-8208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "need",
            "affiliation": "N",
            "endpointDescription": "need",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3588 Edgewood Blvd W",
            "city": "Hernando",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386329383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracy Ellis Burns, PMHNP
• Lexann Pate Bursi, RD, LDN
• Shannon Christian Burt, FNP-C
• Tara Elaine Burt, PT, DPT
• Misty Burton, FNP-C
• Jahed Bushnaq, MD
• Dekimberly Butler, MSW, PCMHT
• Mattie Butler, PLPC
• Joseph Anthony Bynum, M.D.
• Marimichael Hill Byrd, FNP-C

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Southaven, MS
• Providers in Southaven, MS by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.