Kenneth Patrick Buckley, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

120201 Issued in MN

Practice address

1175 Madison Ave
Mankato, MN 56001-5227

Phone

(507) 625-1791

Fax

(507) 625-9262

NPI assigned

May 3, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grand St Paul CVS LLC

  • Pharmacy
  • Plymouth, MN
  • NPI 1437620903
  NPD (past)
• Grand St Paul CVS LLC

  • Pharmacy
  • Mankato, MN
  • NPI 1700180692
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588464000000",
    "number": "1013538818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 MADISON AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015227",
            "telephone_number": "507-625-1791",
            "fax_number": "507-625-9262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 MADISON AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015227",
            "telephone_number": "507-625-1791",
            "fax_number": "507-625-9262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "KENNETH",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-03",
        "last_updated": "2020-05-03",
        "certification_date": "2020-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "120201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "120201",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annika Bruns
• Ashley Ann Bruns
• Kelly Marie Bryan, D.O.
• Jennifer Ellen Buchanan, LICSW
• Tyler Shane Buchanan
• Michele Buckley
• Baylie Alexis Bueltel, LICSW
• Alyssa Jean Buffington
• Angela L H Buffington, PHD LP
• Brandon Robert Bukowski, M.D.

• All providers in Mankato, MN
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.