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General NPI Number Information
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NPI Number | 1720144157
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Entity Type | Organization
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Legal Business Name | BUNTE'S PHARMACY, INC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 115 E MAIN ST.
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City | ZEELAND
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State | MI
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Zip | 49464-1735
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Country | US
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Telephone | 616-772-4685
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Fax |
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Provider Business Mailing Address
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Address Line | 115 E MAIN ST.
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City | ZEELAND
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State | MI
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Zip | 49464-1735
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Country | US
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Telephone | 616-772-4685
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL JAMES VANDE BUNTE
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Credential | R.PH
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Telephone | 616-772-4685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301000358
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License Number State | MI
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