Provider Demographics
NPI:1376850313
Name:BUNTYN, KATY RAWLS (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:RAWLS
Last Name:BUNTYN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6658
Mailing Address - Country:US
Mailing Address - Phone:318-323-8698
Mailing Address - Fax:
Practice Address - Street 1:2810 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6658
Practice Address - Country:US
Practice Address - Phone:318-323-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA18197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist