Provider Demographics
NPI:1013920529
Name:BUCKLEY, JAYNE M (RPH)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:M
Last Name:BUCKLEY
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 1:3 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2601
Mailing Address - Country:US
Mailing Address - Phone:603-448-0319
Mailing Address - Fax:
Practice Address - Street 1:125 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2647
Practice Address - Country:US
Practice Address - Phone:603-443-9563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2080183500000X
MA16513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist