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General NPI Number Information
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NPI Number | 1376842765
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Entity Type | Organization
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Legal Business Name | BUCKLEY BRANDS LLC
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 18021 CONANT ST
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City | DETROIT
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State | MI
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Zip | 48234
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Country | US
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Telephone | 313-368-1000
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Fax | 313-368-1068
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Provider Business Mailing Address
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Address Line | 18021 CONANT ST
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City | DETROIT
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State | MI
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Zip | 48234
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Country | US
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Telephone | 313-368-1000
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Fax | 313-368-1068
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANTHONY COLE
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Credential | PHARMD
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Telephone | 313-971-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009538
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License Number State | MI
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