Healthcare Provider Details

I. General information

NPI: 1548840754
Provider Name (Legal Business Name): ASHLEY BUKSA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 EAST ERIE AVE
PHILADELPHIA PA
19134-1011
US

IV. Provider business mailing address

1305 WEST CHESTER PIKE SUITE 8
HAVERTOWN PA
19083-2929
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5000
  • Fax:
Mailing address:
  • Phone: 610-446-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19888
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454172
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04142100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202215940
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0015509
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: