Healthcare Provider Details

I. General information

NPI: 1073810842
Provider Name (Legal Business Name): TERRY BUHECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 S. MOAPA VALLEY BLVD SUITE 1
OVERTON NV
89040
US

IV. Provider business mailing address

PO BOX 2063
OVERTON NV
89040-2063
US

V. Phone/Fax

Practice location:
  • Phone: 702-397-6100
  • Fax:
Mailing address:
  • Phone: 702-397-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10692
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: