Buckleys Eastside Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010311 Issued in MI

Legal business name

BUCKLEYS EASTSIDE PHARMACY LLC

Practice address

15014 E 8 Mile Rd
Detroit, MI 48205-1352

Phone

(313) 245-0300

Fax

(313) 245-0330

NPI assigned

Feb 3, 2014

Organization subpart

No

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

Authorized official

Name

Anthony Cole

Title

Director of Clinical Services

Phone

(313) 971-5030

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Buckley's Pharmacy #104 Doing business as

Locations

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

{
    "created_epoch": "1391385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1922421528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15014 E 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482051352",
            "telephone_number": "313-245-0300",
            "fax_number": "313-245-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15014 E 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482051352",
            "telephone_number": "313-245-0300",
            "fax_number": "313-245-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKLEYS EASTSIDE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-03",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "313-971-5030"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010311",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144115",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buckley's Pharmacy #104",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Buckley Brands LLC
• Latosha Monique Buckley-Williams
• John D. Buckley, M.D.
• Michelle Elaine Buckley, LMSW
• Patrick Jared Buckley, MD
• Buckleys Pharmacy of Detroit LLC
• Sara Buckner, LLBSW
• Tameko Buckner, MSW
• Harish Budev, MD
• Kameron Ravindra Budhram, DO

• Community/Retail Pharmacy in Detroit, MI
• Providers in Detroit, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.