Buckleys Pharmacy of Hazel Park LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009840 Issued in MI

Legal business name

BUCKLEYS PHARMACY OF HAZEL PARK LLC

Doing business as

Buckley's Pharmacy #102

Practice address

20721 Dequindre Rd Ste B
Hazel Park, MI 48030-2633

Phone

(248) 808-6505

Fax

(248) 808-6351

NPI assigned

Jun 11, 2012

Last updated

Apr 5, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anthony Cole, PHARMDMPHMBAMS

Title

Managing Member

Phone

(313) 971-5030

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Buckley's Pharmacy #102 Doing business as

Locations

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1962764506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20721 DEQUINDRE RD",
            "address_2": "SUITE B",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480302633",
            "telephone_number": "248-808-6505",
            "fax_number": "248-808-6351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20721 DEQUINDRE RD STE B",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480302633",
            "telephone_number": "248-808-6505",
            "fax_number": "248-808-6351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKLEYS PHARMACY OF HAZEL PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "313-971-5030",
        "authorized_official_credential": "PHARMDMPHMBAMS"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2376867",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135482",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buckley's Pharmacy #102",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Hazel Park, MI
• Providers in Hazel Park, 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 Apr 5, 2016; 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.