MEDICARE: BUCKMAN DRUG STORE, 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	183500000X	Pharmacist	00960	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00960	OTHER	TX	PHARMACY LICENSE NUMBER

General Provider Information

NPI Number	:	1588716047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKMAN DRUG STORE, INC.

Provider Business Mailing Address
First Line	:	P. O. BOX 159
Second Line	:
City	:	BOGATA
State	:	TX
Zip	:	75417-0159
Country	:	US
Telephone Number	:	903-632-5811
Fax Number	:	903-632-5812

Provider Business Practice Location Address
First Line	:	125 NORTH MAIN ST.
Second Line	:
City	:	BOGATA
State	:	TX
Zip	:	75417-0159
Country	:	US
Telephone Number	:	903-632-5811
Fax Number	:	903-632-5812

Authorized Official
Title or Position	:	PHARMACIST-IN-CHARGE & SEC.
Name	:	MR. MORRIS L FOSTER
Credential	:	R.PH.
Telephone Number	:	903-632-5811

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/22/2020

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Directions to “BUCKMAN DRUG STORE, INC. ” Practice Location

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