Healthcare Provider Details

I. General information

NPI: 1386657070
Provider Name (Legal Business Name): BUNDY MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE 7TH AVE EAST SUITE D
POLSON MT
59860
US

IV. Provider business mailing address

ONE 7TH AVE EAST SUITE D
POLSON MT
59860
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-0565
  • Fax: 406-883-1878
Mailing address:
  • Phone: 406-883-0565
  • Fax: 406-883-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number32504
License Number StateMT

VIII. Authorized Official

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