Healthcare Provider Details

I. General information

NPI: 1750535167
Provider Name (Legal Business Name): BUNDY MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 7TH AVE E
POLSON MT
59860-3202
US

IV. Provider business mailing address

1 7TH AVE E
POLSON MT
59860-3202
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1106
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1138
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1146
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number730
License Number StateMT

VIII. Authorized Official

Name: SHELLEY SMITH
Title or Position: FINANCE MANAGER
Credential:
Phone: 406-883-0565