Provider Demographics
NPI:1194960450
Name:BUCKHEAD PHARMACEUTICAL ASSOCIATION, INC.
Entity type:Organization
Organization Name:BUCKHEAD PHARMACEUTICAL ASSOCIATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGACHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-261-7775
Mailing Address - Street 1:730 S.O.M. CENTER RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143
Mailing Address - Country:US
Mailing Address - Phone:440-605-0303
Mailing Address - Fax:440-605-1437
Practice Address - Street 1:1299 MCNAUGHTEN ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-866-2120
Practice Address - Fax:614-866-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1913350333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-77690OtherNCPDP
OH02-1913350OtherOHIO STATE BOARD OF PHARMACY