Healthcare Provider Details

I. General information

NPI: 1639629058
Provider Name (Legal Business Name): CARL THOMAS BUHAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4883 W 68TH AVE UNIT 3
WESTMINSTER CO
80030-7607
US

IV. Provider business mailing address

4883 W 68TH AVE UNIT 3
WESTMINSTER CO
80030-7607
US

V. Phone/Fax

Practice location:
  • Phone: 713-885-6113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA0021391
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: