Provider Demographics
NPI:1760082564
Name:BUNDE, MICHAELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:BUNDE
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 1:1860 OUTER LOOP STE 348
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3429
Mailing Address - Country:US
Mailing Address - Phone:605-978-3967
Mailing Address - Fax:
Practice Address - Street 1:1860 OUTER LOOP STE 348
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3429
Practice Address - Country:US
Practice Address - Phone:605-978-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist