Provider Demographics
NPI:1720144157
Name:BUNTE'S PHARMACY, INC
Entity Type:Organization
Organization Name:BUNTE'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VANDE BUNTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-772-4685
Mailing Address - Street 1:115 E MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1735
Mailing Address - Country:US
Mailing Address - Phone:616-772-4685
Mailing Address - Fax:
Practice Address - Street 1:115 E MAIN ST.
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1735
Practice Address - Country:US
Practice Address - Phone:616-772-4685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010003583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2309018OtherNABP
MI2309018Medicaid
MI5301000358OtherPHARMACY LICENSE
MI2309018Medicaid