Provider Demographics
NPI:1124282868
Name:BUNTING PHARMACY LLC
Entity type:Organization
Organization Name:BUNTING PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTING
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:609-335-1192
Mailing Address - Street 1:1337 NEW RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1249
Mailing Address - Country:US
Mailing Address - Phone:609-484-0026
Mailing Address - Fax:609-484-0062
Practice Address - Street 1:1337 NEW RD
Practice Address - Street 2:UNIT A
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1249
Practice Address - Country:US
Practice Address - Phone:609-484-0026
Practice Address - Fax:609-484-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006812003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056312OtherPK
NJ6365720001Medicare NSC