Provider Demographics
NPI:1164766614
Name:BUKOWSKI, BARBARA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:BUKOWSKI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6053 W 99TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3663
Mailing Address - Country:US
Mailing Address - Phone:708-205-6036
Mailing Address - Fax:
Practice Address - Street 1:3153 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2806
Practice Address - Country:US
Practice Address - Phone:708-799-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296140183500000X
IN26024774A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist