=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114272440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER NICOLE BUCHANAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2012
-----------------------------------------------------
Last Update Date | 10/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13500 NC HWY 50/210
-----------------------------------------------------
City | SURF CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-329-1134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1280 ROYAL TERN DR
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28443-7148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-675-9648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 22193
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------