Provider Demographics
NPI:1285272690
Name:BUFFALO RX LLC
Entity type:Organization
Organization Name:BUFFALO RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-542-5724
Mailing Address - Street 1:200 N 15TH ST STE 6A
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4500
Mailing Address - Country:US
Mailing Address - Phone:877-794-3313
Mailing Address - Fax:903-467-3419
Practice Address - Street 1:200 N 15TH ST STE 6A
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4500
Practice Address - Country:US
Practice Address - Phone:877-794-3313
Practice Address - Fax:903-467-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy