Provider Demographics
NPI:1235171893
Name:BUCKHEAD PHARMACEUTICAL ASSOCIATION INC
Entity Type:Organization
Organization Name:BUCKHEAD PHARMACEUTICAL ASSOCIATION INC
Other - Org Name:BUCKHEAD PHARMACEUTICAL ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-605-0303
Mailing Address - Street 1:730 SOM CENTER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2350
Mailing Address - Country:US
Mailing Address - Phone:440-605-0303
Mailing Address - Fax:440-605-1437
Practice Address - Street 1:730 SOM CENTER RD
Practice Address - Street 2:STE 100
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2350
Practice Address - Country:US
Practice Address - Phone:440-605-0303
Practice Address - Fax:440-605-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OH0213951503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079636OtherPK
OH2426520Medicaid
OH2426520Medicaid