Provider Demographics
NPI:1326385931
Name:BUCHSBAUM, MARTY (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTY
Middle Name:
Last Name:BUCHSBAUM
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 1:11650 W PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2501
Mailing Address - Country:US
Mailing Address - Phone:561-470-9376
Mailing Address - Fax:561-470-9383
Practice Address - Street 1:11650 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2501
Practice Address - Country:US
Practice Address - Phone:561-470-9376
Practice Address - Fax:561-470-9383
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist