Provider Demographics
NPI:1336928944
Name:KUNDERT, CORRIE
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:KUNDERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 CLIFFSIDE LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6661
Mailing Address - Country:US
Mailing Address - Phone:916-521-2110
Mailing Address - Fax:
Practice Address - Street 1:2155 GOLDEN CENTRE LN
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4477
Practice Address - Country:US
Practice Address - Phone:916-858-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist