Healthcare Provider Details

I. General information

NPI: 1851929194
Provider Name (Legal Business Name): MICHAEL P WUNDER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 N 52ND ST
PHILADELPHIA PA
19131-4315
US

IV. Provider business mailing address

1 TEAL DR
LANGHORNE PA
19047-8233
US

V. Phone/Fax

Practice location:
  • Phone: 215-377-9531
  • Fax: 215-377-9530
Mailing address:
  • Phone: 215-680-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030330L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01725200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: