Provider Demographics
NPI:1881291797
Name:BUNCE, JEFFREY DOUGLAS (RPH)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DOUGLAS
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 1:4704 127TH STREET CT SW APT A205
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-5863
Mailing Address - Country:US
Mailing Address - Phone:206-999-3144
Mailing Address - Fax:
Practice Address - Street 1:4704 127TH STREET CT SW APT A205
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-5863
Practice Address - Country:US
Practice Address - Phone:206-999-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH2832183500000X
WAPH00010502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist