Provider Demographics
NPI:1649538430
Name:BUFF, GEOFFREY DELANE (RPH)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:DELANE
Last Name:BUFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12114 OLD LINE CTR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2553
Mailing Address - Country:US
Mailing Address - Phone:301-396-9277
Mailing Address - Fax:866-393-5265
Practice Address - Street 1:12114 OLD LINE CTR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2553
Practice Address - Country:US
Practice Address - Phone:301-396-9277
Practice Address - Fax:866-393-5265
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist