Healthcare Provider Details

I. General information

NPI: 1831650969
Provider Name (Legal Business Name): COLLEEN MARIE BUCKS RP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90444 COUNTY ROAD H
MITCHELL NE
69357-1920
US

IV. Provider business mailing address

90444 COUNTY ROAD H
MITCHELL NE
69357-1920
US

V. Phone/Fax

Practice location:
  • Phone: 308-672-4522
  • Fax:
Mailing address:
  • Phone: 308-672-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10302
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: