Healthcare Provider Details

I. General information

NPI: 1134400971
Provider Name (Legal Business Name): CATHERINE BUNDSCHUH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BOWLES AVE
FENTON MO
63026-2338
US

IV. Provider business mailing address

1001 BOWLES AVE
FENTON MO
63026-2338
US

V. Phone/Fax

Practice location:
  • Phone: 636-343-0754
  • Fax:
Mailing address:
  • Phone: 636-343-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2000162830
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: