Provider Demographics
NPI:1639173032
Name:BRUNDAGE, MICHAEL L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:BRUNDAGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GILLETTE DR
Mailing Address - Street 2:
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472-9214
Mailing Address - Country:US
Mailing Address - Phone:570-937-9361
Mailing Address - Fax:
Practice Address - Street 1:238 BELMONT STREET
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-0398
Practice Address - Country:US
Practice Address - Phone:570-488-7979
Practice Address - Fax:570-488-7773
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-045865-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist