Provider Demographics
NPI:1861098667
Name:BUCK, BRENDA (RPH)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 LEWIS BAY RD UNIT 213
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5242
Mailing Address - Country:US
Mailing Address - Phone:610-248-4143
Mailing Address - Fax:
Practice Address - Street 1:89 LEWIS BAY RD UNIT 213
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5242
Practice Address - Country:US
Practice Address - Phone:610-248-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist