Provider Demographics
NPI:1053396507
Name:ROBERT G BUXTON
Entity type:Organization
Organization Name:ROBERT G BUXTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-689-4748
Mailing Address - Street 1:111 N BUCKEYE ST
Mailing Address - Street 2:P.O. BOX 137
Mailing Address - City:OSGOOD
Mailing Address - State:IN
Mailing Address - Zip Code:47037-1133
Mailing Address - Country:US
Mailing Address - Phone:812-689-4748
Mailing Address - Fax:812-689-0156
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:812-689-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004246A183500000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1253640001OtherPTAN
IN100177830AMedicaid