=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033562145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK A BUCHANAN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2016
-----------------------------------------------------
Last Update Date | 07/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 E CHURCH ST
-----------------------------------------------------
City | ATMORE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36502-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-259-0704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8748 LAREDO ST
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-259-0704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 19156
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | PS33306
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------