Healthcare Provider Details

I. General information

NPI: 1750777306
Provider Name (Legal Business Name): MICHAEL WUNDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E ROCK ISLAND AVE
BOYD TX
76023-3070
US

IV. Provider business mailing address

113 E ROCK ISLAND AVE
BOYD TX
76023-3070
US

V. Phone/Fax

Practice location:
  • Phone: 940-433-8056
  • Fax: 940-433-8059
Mailing address:
  • Phone: 940-433-8056
  • Fax: 940-433-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: