Provider Demographics
NPI:1801062427
Name:BUCKHORN PHARMACY LLC
Entity type:Organization
Organization Name:BUCKHORN PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-272-0015
Mailing Address - Street 1:1085 SOPCHOPPY HWY
Mailing Address - Street 2:STE 1A
Mailing Address - City:SOPCHOPPY
Mailing Address - State:FL
Mailing Address - Zip Code:32358-1016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1085 SOPCHOPPY HWY
Practice Address - Street 2:STE 1A
Practice Address - City:SOPCHOPPY
Practice Address - State:FL
Practice Address - Zip Code:32358-1016
Practice Address - Country:US
Practice Address - Phone:850-962-2166
Practice Address - Fax:850-877-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-03
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH235763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1039230OtherNCPDP PROVIDER IDENTIFICATION NUMBER