Provider Demographics
NPI:1841589876
Name:BUNDY, CAROLINE P (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:P
Last Name:BUNDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2423
Mailing Address - Country:US
Mailing Address - Phone:276-628-3511
Mailing Address - Fax:276-628-3952
Practice Address - Street 1:711 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2423
Practice Address - Country:US
Practice Address - Phone:276-628-3511
Practice Address - Fax:276-628-3952
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020038421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA02020003842OtherVIRGINIA BOARD OF PHARMACY LICENSE