Healthcare Provider Details

I. General information

NPI: 1558655373
Provider Name (Legal Business Name): BRYAN JOHN BUECHEL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAYO CLINIC PHARMACY 200 FIRST STREET SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

4501 PARK GLEN RD APT 137
ST LOUIS PARK MN
55416-4872
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 920-979-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15682-40
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119743
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: