Healthcare Provider Details

I. General information

NPI: 1811075666
Provider Name (Legal Business Name): BUNDY MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 1ST ST
HAMILTON MT
59840-3115
US

IV. Provider business mailing address

ONE 7TH AVE EAST
POLSON MT
59860
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-6203
  • Fax: 406-363-7583
Mailing address:
  • Phone: 406-883-0565
  • Fax: 406-883-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number10575
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1106
License Number StateMT

VIII. Authorized Official

Name: MISS VICKEE LEE SIEMERS
Title or Position: PRESIDENT/OWNER
Credential: RPH
Phone: 406-883-0565