Provider Demographics
NPI:1275189854
Name:BUCKINGHAM, DUSTIN S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:S
Last Name:BUCKINGHAM
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 1:25737 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3221
Mailing Address - Country:US
Mailing Address - Phone:315-629-2402
Mailing Address - Fax:
Practice Address - Street 1:25737 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3221
Practice Address - Country:US
Practice Address - Phone:315-629-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist