Organization
BUCKLEYS PHARMACY OF HAZEL PARK LLC
Active
Other names
Buckley's Pharmacy #102
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY COLE PHARMDMPHMBAMS (MANAGING MEMBER)
(313) 971-5030
Entity
Organization
Contact information
Practice address
20721 DEQUINDRE RD STE B, HAZEL PARK, MI 48030-2633
(248) 808-6505
(248) 808-6351
Mailing address
20721 DEQUINDRE RD, SUITE B, HAZEL PARK, MI 48030-2633
(248) 808-6505
(248) 808-6351
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009840
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135482
PK
—
05
—
2376867
—
MI
Enumeration date
06/11/2012
Last updated
04/05/2016
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