Healthcare Provider Details

I. General information

NPI: 1710203575
Provider Name (Legal Business Name): LAURENE L WUNDER R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 STONY HILL RD
YARDLEY PA
19067-4419
US

IV. Provider business mailing address

1 TEAL DR
LANGHORNE PA
19047-8233
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-9143
  • Fax: 215-321-3017
Mailing address:
  • Phone: 215-702-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP032175L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: