Healthcare Provider Details

I. General information

NPI: 1912197658
Provider Name (Legal Business Name): THEODORE MICHAEL BUJAK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 STILLWATER DR
DAYTON NV
89403-9029
US

IV. Provider business mailing address

325 STILLWATER DR
DAYTON NV
89403-9029
US

V. Phone/Fax

Practice location:
  • Phone: 775-246-7268
  • Fax: 775-246-7268
Mailing address:
  • Phone: 775-246-7268
  • Fax: 775-246-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10230
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: