Healthcare Provider Details

I. General information

NPI: 1700884467
Provider Name (Legal Business Name): MICHAEL BUNCE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 E GRAND RIVER AVE STE 101
LANSING MI
48912-4335
US

IV. Provider business mailing address

2909 E GRAND RIVER AVE STE 101
LANSING MI
48912-4335
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-8640
  • Fax: 517-364-8641
Mailing address:
  • Phone: 517-364-8640
  • Fax: 517-364-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: