Provider Demographics
NPI:1770133621
Name:BUCKINGHAM, TYRONE MAURICE (RPH)
Entity type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:MAURICE
Last Name:BUCKINGHAM
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 1:9130 N COUNTY ROAD 1000 W
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47232-9474
Mailing Address - Country:US
Mailing Address - Phone:812-579-9706
Mailing Address - Fax:
Practice Address - Street 1:1125 W JEFFERSON ST
Practice Address - Street 2:PHARMACY
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2140
Practice Address - Country:US
Practice Address - Phone:317-736-3430
Practice Address - Fax:317-738-7870
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018922A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist