Provider Demographics
NPI:1568741205
Name:BUCHANAN, MARK ALLAN (MSPHARM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4602
Mailing Address - Country:US
Mailing Address - Phone:916-922-8752
Mailing Address - Fax:916-929-9670
Practice Address - Street 1:2214 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4602
Practice Address - Country:US
Practice Address - Phone:916-922-8752
Practice Address - Fax:916-929-9670
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist