Stan Buczko RPH

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

STAN BUCZKO RPH

Doing business as

Medicine Shoppe

Practice address

490 N Main St
Canton, IL 61520-1828

Phone

(309) 647-1717

Fax

(309) 647-1734

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Stan Buczko, RPH

Title

Owner Pharmacist

Phone

(309) 647-1717

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• MEDICINE SHOPPE Doing business as

Locations

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1780756569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 N MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615201828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 N MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615201828",
            "telephone_number": "309-647-1717",
            "fax_number": "309-647-1734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAN BUCZKO RPH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BUCZKO",
        "authorized_official_first_name": "STAN",
        "authorized_official_title_or_position": "OWNER PHARMACIST",
        "authorized_official_telephone_number": "309-647-1717",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1448857",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carissa Elizabeth Slobodecki, DPT
• Jimmie Marquette Smith, MD
• Spoon River Counseling & Wellness PLLC
• Spoon River Family Practice Center, Inc
• Spoon River Hearing Services Inc
• Andrea Steliga-Phillips, PSYD
• Amanda L Stephenson, DPT
• Fordyce Edward Stivers, MD
• Cassie J Stone, CFNP
• Sunset Rehabilitation & Health Care Center LLC

• Community/Retail Pharmacy in Canton, IL
• Providers in Canton, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.