Provider Demographics
NPI:1841516531
Name:BUCKLEY, ANDREW HOWELL (RPH)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:HOWELL
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TH AVENUE & C ST
Mailing Address - Street 2:ATTN: DEPT 521 - OUTPATIENT PHARMACY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84143-0001
Mailing Address - Country:US
Mailing Address - Phone:801-408-1122
Mailing Address - Fax:801-408-5172
Practice Address - Street 1:8 TH AVENUE & C ST
Practice Address - Street 2:ATTN: DEPT 521 - OUTPATIENT PHARMACY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-1122
Practice Address - Fax:801-408-5172
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT368989-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist