Provider Demographics
NPI:1275817421
Name:GOUGEMANN, BUFFY A
Entity Type:Individual
Prefix:MRS
First Name:BUFFY
Middle Name:A
Last Name:GOUGEMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 JORDAN CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3869
Mailing Address - Country:US
Mailing Address - Phone:678-823-4978
Mailing Address - Fax:678-823-4950
Practice Address - Street 1:2855 JORDAN COURT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:678-823-4978
Practice Address - Fax:678-823-4950
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist