MEDICARE: MICHAEL P WUNDER RPH

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	RP030330L	PA
2	183500000X	Pharmacist	28RI01725200	NJ

General Provider Information

NPI Number	:	1851929194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL P WUNDER RPH

Provider Business Mailing Address
First Line	:	1 TEAL DR
Second Line	:
City	:	LANGHORNE
State	:	PA
Zip	:	19047-8233
Country	:	US
Telephone Number	:	215-680-2491
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-4315
Country	:	US
Telephone Number	:	215-377-9531
Fax Number	:	215-377-9530

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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