Provider Demographics
NPI:1518089788
Name:BUCKLEY, DONALD JAM,ES (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JAM,ES
Last Name:BUCKLEY
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 1:1074 66TH ST
Mailing Address - Street 2:PO BOX 274
Mailing Address - City:GLENN
Mailing Address - State:MI
Mailing Address - Zip Code:49416
Mailing Address - Country:US
Mailing Address - Phone:269-227-3050
Mailing Address - Fax:
Practice Address - Street 1:955 S BAILEY
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090
Practice Address - Country:US
Practice Address - Phone:269-639-2858
Practice Address - Fax:269-639-2860
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist