Provider Demographics
NPI:1376056895
Name:BUDUAN, DAISY (RPH)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:BUDUAN
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:PO BOX 10001
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8901
Mailing Address - Country:US
Mailing Address - Phone:670-236-8335
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 500409
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-0409
Practice Address - Country:US
Practice Address - Phone:670-236-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist