Provider Demographics
NPI:1316229164
Name:BUCKLAND, BOBBY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:ANN
Last Name:BUCKLAND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-8555
Mailing Address - Country:US
Mailing Address - Phone:419-782-2499
Mailing Address - Fax:
Practice Address - Street 1:1829 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-8555
Practice Address - Country:US
Practice Address - Phone:419-782-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist