Provider Demographics
NPI:1649302803
Name:BUKER COLSON MEDICINE CHEST
Entity type:Organization
Organization Name:BUKER COLSON MEDICINE CHEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:RUSTIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-237-4171
Mailing Address - Street 1:1300 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703
Mailing Address - Country:US
Mailing Address - Phone:559-237-4171
Mailing Address - Fax:
Practice Address - Street 1:1300 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3845
Practice Address - Country:US
Practice Address - Phone:559-237-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY390523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA390520Medicaid
CA0550601OtherNCPDP