Provider Demographics
NPI:1811587926
Name:BUCHTA, KRISTINA (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BUCHTA
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 1:713 COUNTY ROAD 1435 N
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-4827
Mailing Address - Country:US
Mailing Address - Phone:618-383-5373
Mailing Address - Fax:
Practice Address - Street 1:1344 ILLINOIS HWY 1
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1632
Practice Address - Country:US
Practice Address - Phone:618-382-5838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist