Active NPI
Kenyon Bush, PHARMD
- Pharmacist
- Rosedale, MD
National Provider Identifier
1306448964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17774
- Practice address
- 6420 Petrie Way
Rosedale, MD 21237-3034 - Phone
- (410) 687-6832
- NPI assigned
- Nov 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202211164 | VA | |
| Pharmacist | 183500000X | 17774 | MD | Primary |
Addresses
Primary practice location
6420 Petrie Way
Rosedale, MD 21237-3034
Mailing address
9006 Yellow Brick Rd
Rosedale, MD 21237-2309
Phone (443) 927-8400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17774 | MD | MD | Specialist |
| 0202211164 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1306448964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9006 YELLOW BRICK RD",
"city": "ROSEDALE",
"state": "MD",
"postal_code": "212372309",
"telephone_number": "443-927-8400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6420 PETRIE WAY",
"city": "ROSEDALE",
"state": "MD",
"postal_code": "212373034",
"telephone_number": "410-687-6832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "KENYON",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-09",
"last_updated": "2022-03-28",
"certification_date": "2022-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202211164",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "17774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rosedale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.