Provider Demographics
NPI:1023514767
Name:BUKSTEIN, MICHAEL JEROME JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEROME
Last Name:BUKSTEIN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16841 WINSTON CIR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-2522
Mailing Address - Country:US
Mailing Address - Phone:309-261-3839
Mailing Address - Fax:
Practice Address - Street 1:250 SE GATEWAY DR
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2045
Practice Address - Country:US
Practice Address - Phone:515-986-0101
Practice Address - Fax:515-986-3382
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003024792183500000X
IL051287243183500000X
IA21800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist