1538591375 NPI number — BUCKEYE PHARMACY

Table of content: (NPI 1538591375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538591375 NPI number — BUCKEYE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKEYE PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BUCKEYE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538591375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 S. BUCKNER BLVD
Provider Second Line Business Mailing Address:
# 127
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-391-7441
Provider Business Mailing Address Fax Number:
214-391-7443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 AMERICAN DR STE 101B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-6188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
121-439-1744
Provider Business Practice Location Address Fax Number:
214-391-7443
Provider Enumeration Date:
08/04/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TENII
Authorized Official First Name:
ISSIFU
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
614-599-5576

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 29040 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 146899 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2144319 . This is a "PK" identifier . This identifiers is of the category "OTHER".