Provider Demographics
NPI:1275649527
Name:BUKMIR, JOHN MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARK
Last Name:BUKMIR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRILLIANT
Mailing Address - State:OH
Mailing Address - Zip Code:43913-1049
Mailing Address - Country:US
Mailing Address - Phone:740-598-4755
Mailing Address - Fax:740-598-3112
Practice Address - Street 1:908 3RD ST
Practice Address - Street 2:
Practice Address - City:BRILLIANT
Practice Address - State:OH
Practice Address - Zip Code:43913-1049
Practice Address - Country:US
Practice Address - Phone:740-598-4755
Practice Address - Fax:740-598-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0830186Medicaid
OH0830186Medicaid