Provider Demographics
NPI:1174994008
Name:BUCK, MICHELLE MARIA (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIA
Last Name:BUCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MA SOCORRO
Other - Middle Name:
Other - Last Name:DELOS REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2271 BEL PRE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2204
Mailing Address - Country:US
Mailing Address - Phone:301-598-6617
Mailing Address - Fax:
Practice Address - Street 1:2271 BEL PRE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2204
Practice Address - Country:US
Practice Address - Phone:301-598-6617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39393183500000X
MD18689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist