Basic Information
| Provider Information | |||||||||
| NPI: | 1952869711 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BUCK RX, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5806 BRECKENRIDGE PKWY STE B | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336104211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548540707 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5806 BRECKENRIDGE PKWY STE B | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336104211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548540707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 03/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROSE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP/GENERAL MANAGERT | ||||||||
| AuthorizedOfficialTelephone: | 9548540707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.