Healthcare Provider Details

I. General information

NPI: 1487235115
Provider Name (Legal Business Name): NADIA KAROL BUKACZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 S BROAD ST
TRENTON NJ
08611-1819
US

IV. Provider business mailing address

239 AMBERFIELD DR
MOUNT LAUREL NJ
08054-5128
US

V. Phone/Fax

Practice location:
  • Phone: 609-858-7560
  • Fax:
Mailing address:
  • Phone: 856-912-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02281700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: