Healthcare Provider Details

I. General information

NPI: 1053396507
Provider Name (Legal Business Name): ROBERT G BUXTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N BUCKEYE ST
OSGOOD IN
47037-1133
US

IV. Provider business mailing address

111 N BUCKEYE ST P.O. BOX 137
OSGOOD IN
47037-1133
US

V. Phone/Fax

Practice location:
  • Phone: 812-689-4748
  • Fax: 812-689-0156
Mailing address:
  • Phone: 812-689-4748
  • Fax: 812-689-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60004246A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number60004246A
License Number StateIN

VIII. Authorized Official

Name: ROBERT G BUXTON
Title or Position: OWNER
Credential: RPH
Phone: 812-689-4748