MEDICARE: BUCKHEAD PHARMACEUTICAL ASSOCIATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	021395150	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2079636	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235171893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKHEAD PHARMACEUTICAL ASSOCIATION INC

Provider Business Mailing Address
First Line	:	730 SOM CENTER RD
Second Line	:	STE 100
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2350
Country	:	US
Telephone Number	:	440-605-0303
Fax Number	:	440-605-1437

Provider Business Practice Location Address
First Line	:	730 SOM CENTER RD
Second Line	:	STE 100
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2350
Country	:	US
Telephone Number	:	440-605-0303
Fax Number	:	440-605-1437

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID BRAGINSKY
Credential	:
Telephone Number	:	440-605-0303

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/19/2018

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Directions to “BUCKHEAD PHARMACEUTICAL ASSOCIATION INC ” Practice Location

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