Provider Demographics
NPI:1013512672
Name:BUCHSBAUM, GARY ROBERT
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ROBERT
Last Name:BUCHSBAUM
Suffix:
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 1:11586 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3019
Mailing Address - Country:US
Mailing Address - Phone:561-622-0702
Mailing Address - Fax:
Practice Address - Street 1:11586 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33408-3019
Practice Address - Country:US
Practice Address - Phone:561-622-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist