Provider Demographics
NPI:1356758544
Name:BUNT, BERNADINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BERNADINE
Middle Name:
Last Name:BUNT
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 1:475 W FINNIE FLAT RD
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-7398
Mailing Address - Country:US
Mailing Address - Phone:928-567-2274
Mailing Address - Fax:
Practice Address - Street 1:475 W FINNIE FLAT RD
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7398
Practice Address - Country:US
Practice Address - Phone:928-567-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020237183500000X
WY3660183500000X
CO0020073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist