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General NPI Number Information
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NPI Number | 1861882599
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Entity Type | Organization
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Legal Business Name | BUCKLEYS PHARMACY OF WARREN LLC
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 29200 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092-4242
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Country | US
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Telephone | 586-558-8787
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Fax | 586-558-8793
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Provider Business Mailing Address
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Address Line | 29200 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092-4242
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Country | US
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Telephone | 586-558-8787
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Fax | 586-558-8793
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | ANTHONY COLE
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Credential | PHARMDMPHMBAMS
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Telephone | 586-558-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010625
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License Number State | MI
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