Provider Demographics
NPI:1922160084
Name:BUCHANAN, MICHAEL L SR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:BUCHANAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-0096
Mailing Address - Country:US
Mailing Address - Phone:903-660-2012
Mailing Address - Fax:903-668-2015
Practice Address - Street 1:100 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650-0096
Practice Address - Country:US
Practice Address - Phone:903-660-2012
Practice Address - Fax:903-668-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4521527OtherNCPD
TX140154Medicaid
TX0978700001Medicare ID - Type Unspecified