Provider Demographics
NPI:1679018618
Name:BUCKLEY, MARY AMANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:AMANDA
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 6TH AVE N
Mailing Address - Street 2:#202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5055
Mailing Address - Country:US
Mailing Address - Phone:703-577-1370
Mailing Address - Fax:
Practice Address - Street 1:118 6TH AVE N
Practice Address - Street 2:#202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5055
Practice Address - Country:US
Practice Address - Phone:703-577-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60665716183500000X
VA0202212593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist