Healthcare Provider Details

I. General information

NPI: 1194189530
Provider Name (Legal Business Name): ELIZABETH BUEKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 US HIGHWAY 301 N
ELLENTON FL
34222-3016
US

IV. Provider business mailing address

6126 US HIGHWAY 301 N
ELLENTON FL
34222-3016
US

V. Phone/Fax

Practice location:
  • Phone: 941-729-7844
  • Fax: 847-376-2977
Mailing address:
  • Phone: 941-729-7844
  • Fax: 847-376-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS26415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: