Healthcare Provider Details

I. General information

NPI: 1720345747
Provider Name (Legal Business Name): JOSEPH B BUHANAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2012
Last Update Date: 04/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

IV. Provider business mailing address

4141 E LONG MOUNTAIN RANCH RD
KINGMAN AZ
86401-9604
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-0618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018298
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberS018298
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: