Provider Demographics
NPI:1598046815
Name:BUCKLEY, HEIDI SUZANNE (RPH)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUZANNE
Last Name:BUCKLEY
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 1:1207 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1325
Mailing Address - Country:US
Mailing Address - Phone:630-897-7112
Mailing Address - Fax:630-897-7594
Practice Address - Street 1:1207 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1325
Practice Address - Country:US
Practice Address - Phone:630-897-7112
Practice Address - Fax:630-897-7594
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist