Healthcare Provider Details

I. General information

NPI: 1932634151
Provider Name (Legal Business Name): KELLY BUXTON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MARION WALDO RD
MARION OH
43302-7422
US

IV. Provider business mailing address

1428 MARION WALDO RD
MARION OH
43302-7422
US

V. Phone/Fax

Practice location:
  • Phone: 740-386-2321
  • Fax: 740-389-2795
Mailing address:
  • Phone: 740-386-2321
  • Fax: 740-389-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03324171
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: