Provider Demographics
NPI:1780134684
Name:BUNIN, CHARLES RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RICHARD
Last Name:BUNIN
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 1:1123 PUDDINGSTONE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2009
Mailing Address - Country:US
Mailing Address - Phone:908-232-8571
Mailing Address - Fax:
Practice Address - Street 1:1123 PUDDINGSTONE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2009
Practice Address - Country:US
Practice Address - Phone:908-232-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R100978300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28R100978300OtherPHARMACY LICENSE