Healthcare Provider Details

I. General information

NPI: 1558849299
Provider Name (Legal Business Name): MARCIA DIANE BUESCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S MAIN ST
SIKESTON MO
63801-9360
US

IV. Provider business mailing address

154 TRANQUILITY TRL
JACKSON MO
63755-8600
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-6775
  • Fax:
Mailing address:
  • Phone: 573-243-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040578
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: