Organization
BUCKLEYS EASTSIDE PHARMACY LLC
Active
Other names
Buckley's Pharmacy #104
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY COLE (DIRECTOR OF CLINICAL SERVICES)
(313) 971-5030
Entity
Organization
Contact information
Practice address
15014 E 8 MILE RD, DETROIT, MI 48205-1352
(313) 245-0300
(313) 245-0330
Mailing address
15014 E 8 MILE RD, DETROIT, MI 48205-1352
(313) 245-0300
(313) 245-0330
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010311
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144115
PK
—
Enumeration date
02/03/2014
Last updated
02/03/2014
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