Healthcare Provider Details

I. General information

NPI: 1184629362
Provider Name (Legal Business Name): BUCHHEIT DRUG CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 W CENTRAL AVE
JAMESTOWN TN
38556-3407
US

IV. Provider business mailing address

PO BOX 610
JAMESTOWN TN
38556-0610
US

V. Phone/Fax

Practice location:
  • Phone: 931-879-8133
  • Fax: 931-879-9365
Mailing address:
  • Phone: 931-879-8133
  • Fax: 931-879-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0000001962
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. RAYELLA JO VAUGHN
Title or Position: OWNER - PHARMACIST
Credential: PHARM D
Phone: 931-879-8133