Provider Demographics
NPI:1235263765
Name:BUFFALO DRUGS INC
Entity Type:Organization
Organization Name:BUFFALO DRUGS INC
Other - Org Name:THREE OAKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-756-9594
Mailing Address - Street 1:19 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:THREE OAKS
Mailing Address - State:MI
Mailing Address - Zip Code:49128-1117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 N ELM ST
Practice Address - Street 2:
Practice Address - City:THREE OAKS
Practice Address - State:MI
Practice Address - Zip Code:49128-1117
Practice Address - Country:US
Practice Address - Phone:269-756-9595
Practice Address - Fax:269-756-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301003910333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2318839Medicaid
2336231OtherOTHER ID NUMBER
2336231OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI2336231Medicaid
1171770001Medicare NSC