Provider Demographics
NPI:1639391493
Name:JOHN MARK BUKMIR
Entity Type:Organization
Organization Name:JOHN MARK BUKMIR
Other - Org Name:BUKMIRS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH. OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BUKMIR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-598-4755
Mailing Address - Street 1:908 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRILLIANT
Mailing Address - State:OH
Mailing Address - Zip Code:43913-1049
Mailing Address - Country:US
Mailing Address - Phone:740-598-4755
Mailing Address - Fax:740-598-3112
Practice Address - Street 1:908 3RD ST
Practice Address - Street 2:
Practice Address - City:BRILLIANT
Practice Address - State:OH
Practice Address - Zip Code:43913-1049
Practice Address - Country:US
Practice Address - Phone:740-598-4755
Practice Address - Fax:740-598-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0830186Medicaid
0518930001Medicare NSC