Provider Demographics
NPI:1255132551
Name:BULLER, BASAK (RPH)
Entity type:Individual
Prefix:
First Name:BASAK
Middle Name:
Last Name:BULLER
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2244
Mailing Address - Country:US
Mailing Address - Phone:970-670-0545
Mailing Address - Fax:
Practice Address - Street 1:3690 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2244
Practice Address - Country:US
Practice Address - Phone:970-670-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist