Provider Demographics
NPI:1811972045
Name:BUXTON, ROBERT G (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:BUXTON
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 1:125 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OSGOOD
Mailing Address - State:IN
Mailing Address - Zip Code:47037-1236
Mailing Address - Country:US
Mailing Address - Phone:812-689-4748
Mailing Address - Fax:
Practice Address - Street 1:111 N BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:OSGOOD
Practice Address - State:IN
Practice Address - Zip Code:47037-1133
Practice Address - Country:US
Practice Address - Phone:812-689-4748
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013281A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1253640001Medicare ID - Type Unspecified