Provider Demographics
NPI:1417383274
Name:BUNKOFSKE, AMITY JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMITY
Middle Name:JEAN
Last Name:BUNKOFSKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMITY
Other - Middle Name:JEAN
Other - Last Name:WICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1654 N PEBBLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2571
Mailing Address - Country:US
Mailing Address - Phone:623-207-6808
Mailing Address - Fax:623-207-6814
Practice Address - Street 1:1654 N PEBBLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2571
Practice Address - Country:US
Practice Address - Phone:623-207-6808
Practice Address - Fax:623-207-6814
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist