Healthcare Provider Details

I. General information

NPI: 1720144157
Provider Name (Legal Business Name): BUNTE'S PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST.
ZEELAND MI
49464-1735
US

IV. Provider business mailing address

115 E MAIN ST.
ZEELAND MI
49464-1735
US

V. Phone/Fax

Practice location:
  • Phone: 616-772-4685
  • Fax:
Mailing address:
  • Phone: 616-772-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301000358
License Number StateMI

VIII. Authorized Official

Name: MR. MICHAEL JAMES VANDE BUNTE
Title or Position: PRESIDENT
Credential: R.PH
Phone: 616-772-4685