Healthcare Provider Details

I. General information

NPI: 1336497247
Provider Name (Legal Business Name): KEVIN SAMUEL BUNTMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 W INDIAN SCHOOL RD
BUCKEYE AZ
85396-2027
US

IV. Provider business mailing address

19600 W INDIAN SCHOOL RD
BUCKEYE AZ
85396-2027
US

V. Phone/Fax

Practice location:
  • Phone: 623-265-7201
  • Fax: 623-265-7202
Mailing address:
  • Phone: 623-265-7201
  • Fax: 623-265-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS019176
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: