Organization
BUCKLEYS PHARMACY OF WARREN LLC
Active
Other names
Buckley's Pharmacy #105
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY COLE PHARMDMPHMBAMS (DIRECTOR OF CLINICAL SERVICES)
(586) 558-8787
Entity
Organization
Contact information
Practice address
29200 RYAN RD, WARREN, MI 48092-4242
(586) 558-8787
(586) 558-8793
Mailing address
29200 RYAN RD, WARREN, MI 48092-4242
(586) 558-8787
(586) 558-8793
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010625
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150063
PK
—
05
—
2365600
—
MI
Enumeration date
02/03/2015
Last updated
04/05/2016
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