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Organization
STAN BUCZKO RPH
Active
Organization
STAN BUCZKO RPH
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
STAN BUCZKO RPH (OWNER PHARMACIST)
(309) 647-1717
Entity
Organization
Contact information
Practice address
490 N MAIN ST, CANTON, IL 61520-1828
(309) 647-1717
(309) 647-1734
Mailing address
490 N MAIN ST, CANTON, IL 61520-1828
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1448857
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/15/2006
Last updated
03/07/2023
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