MEDICARE: DR. BUNNAUN UCH PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	048460	CA

General Provider Information

NPI Number	:	1437432176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BUNNAUN UCH PHARM D

Provider Business Mailing Address
First Line	:	4555 N PERSHING AVE STE 7
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6739
Country	:	US
Telephone Number	:	209-473-4706
Fax Number	:	209-473-7377

Provider Business Practice Location Address
First Line	:	4555 N PERSHING AVE STE 7
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6739
Country	:	US
Telephone Number	:	209-473-4706
Fax Number	:	209-473-7377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	04/08/2015

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Directions to “ DR. BUNNAUN UCH PHARM D” Practice Location

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