Provider Demographics
NPI:1932747813
Name:BUNTON, WILSON JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:JAMES
Last Name:BUNTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 SUNFOREST CT STE 124
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4476
Mailing Address - Country:US
Mailing Address - Phone:419-473-0891
Mailing Address - Fax:419-473-0899
Practice Address - Street 1:3900 SUNFOREST CT STE 124
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4476
Practice Address - Country:US
Practice Address - Phone:419-473-0891
Practice Address - Fax:419-473-0899
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03135539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03135539OtherPHARMACIST LICENSE
MI5302040518OtherPHARMACIST LICENSE