Provider Demographics
NPI:1013136191
Name:BUNGAY, KATHLEEN (PHARMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:BUNGAY
Suffix:
Gender:F
Credentials:PHARMD, MS
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:BUNGAY
Other - Last Name:MASSARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD MS
Mailing Address - Street 1:10 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1711
Mailing Address - Country:US
Mailing Address - Phone:781-639-2584
Mailing Address - Fax:617-636-8351
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:THE HEALTH INSTITUTE, BOX 345
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-3292
Practice Address - Fax:617-636-8351
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237101835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric