Healthcare Provider Details

I. General information

NPI: 1083201479
Provider Name (Legal Business Name): JACQUELINE BUCKLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE NGUYEN PHARMD

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

211 WESTWIND DR
COPPELL TX
75019-3167
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76327
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-01440
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237062
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: