Healthcare Provider Details

I. General information

NPI: 1235263765
Provider Name (Legal Business Name): BUFFALO DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 N ELM ST
THREE OAKS MI
49128-1117
US

IV. Provider business mailing address

19 N ELM ST
THREE OAKS MI
49128-1117
US

V. Phone/Fax

Practice location:
  • Phone: 269-756-9595
  • Fax: 269-756-7433
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301003910
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARCIA SMELLING
Title or Position: RPH
Credential:
Phone: 269-756-9594