Provider Demographics
NPI:1073936951
Name:BUCKLEY, LAURA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N HIGHWAY 90 BYP
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2204
Mailing Address - Country:US
Mailing Address - Phone:520-458-9690
Mailing Address - Fax:520-458-8729
Practice Address - Street 1:500 N HIGHWAY 90 BYP
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2204
Practice Address - Country:US
Practice Address - Phone:520-458-9690
Practice Address - Fax:520-458-8729
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist