Provider Demographics
NPI:1164944013
Name:BUNN, LIZETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:BUNN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 TUXEDO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3713
Mailing Address - Country:US
Mailing Address - Phone:210-843-2833
Mailing Address - Fax:
Practice Address - Street 1:4647 MEDICAL DR # MS 102-1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4403
Practice Address - Country:US
Practice Address - Phone:210-358-8680
Practice Address - Fax:210-358-8689
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX502591835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care