MEDICARE: MR. ALLEN JOSEPH BUNN R.PH.

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	28RI01529000	NJ

General Provider Information

NPI Number	:	1528392032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN JOSEPH BUNN R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 323
Second Line	:	619 RTE 539
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-0323
Country	:	US
Telephone Number	:	609-758-4726
Fax Number	:	609-758-6123

Provider Business Practice Location Address
First Line	:	619 ROUTE 539
Second Line	:
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-2334
Country	:	US
Telephone Number	:	609-758-4726
Fax Number	:	609-758-6123

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

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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