Healthcare Provider Details

I. General information

NPI: 1558942722
Provider Name (Legal Business Name): IRIONAH BUCHANAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MARKET AVE N
CANTON OH
44702-1417
US

IV. Provider business mailing address

1518 3RD ST NE
CANTON OH
44704-1708
US

V. Phone/Fax

Practice location:
  • Phone: 330-452-7762
  • Fax:
Mailing address:
  • Phone: 330-209-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number09109055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: