Provider Demographics
NPI:1518509983
Name:BUCK, JANE ELLEN (RPH)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:BUCK
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 111
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-0111
Mailing Address - Country:US
Mailing Address - Phone:641-394-4156
Mailing Address - Fax:641-394-4155
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-2101
Practice Address - Country:US
Practice Address - Phone:641-394-4156
Practice Address - Fax:641-394-4155
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist