MEDICARE: DR. MICHAEL WUNDER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	53056	TX

General Provider Information

NPI Number	:	1750777306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WUNDER PHARMD

Provider Business Mailing Address
First Line	:	113 E ROCK ISLAND AVE
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-3070
Country	:	US
Telephone Number	:	940-433-8056
Fax Number	:	940-433-8059

Provider Business Practice Location Address
First Line	:	113 E ROCK ISLAND AVE
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-3070
Country	:	US
Telephone Number	:	940-433-8056
Fax Number	:	940-433-8059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	04/10/2015

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