Provider Demographics
NPI:1033562145
Name:BUCHANAN, MARK A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8748 LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2130
Mailing Address - Country:US
Mailing Address - Phone:850-259-0704
Mailing Address - Fax:
Practice Address - Street 1:506 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-2626
Practice Address - Country:US
Practice Address - Phone:850-259-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL191561835P1200X
FLPS333061835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy