Provider Demographics
NPI:1588716047
Name:BUCKMAN DRUG STORE, INC.
Entity type:Organization
Organization Name:BUCKMAN DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE & SEC.
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-632-5811
Mailing Address - Street 1:P. O. BOX 159
Mailing Address - Street 2:
Mailing Address - City:BOGATA
Mailing Address - State:TX
Mailing Address - Zip Code:75417-0159
Mailing Address - Country:US
Mailing Address - Phone:903-632-5811
Mailing Address - Fax:903-632-5812
Practice Address - Street 1:125 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:BOGATA
Practice Address - State:TX
Practice Address - Zip Code:75417-0159
Practice Address - Country:US
Practice Address - Phone:903-632-5811
Practice Address - Fax:903-632-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140636Medicaid
TX00960OtherPHARMACY LICENSE NUMBER
1189550001Medicare NSC