Provider Demographics
NPI:1700884467
Name:BUNCE, MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BUNCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 E GRAND RIVER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4335
Mailing Address - Country:US
Mailing Address - Phone:517-364-8640
Mailing Address - Fax:517-364-8641
Practice Address - Street 1:2909 E GRAND RIVER AVE STE 101
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4335
Practice Address - Country:US
Practice Address - Phone:517-364-8640
Practice Address - Fax:517-364-8641
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist