Provider Demographics
NPI:1194439554
Name:BUNTINGS SPECIALTY CARE RX
Entity type:Organization
Organization Name:BUNTINGS SPECIALTY CARE RX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:VERNON ARTHUR
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-466-3600
Mailing Address - Street 1:1885 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3605
Mailing Address - Country:US
Mailing Address - Phone:276-466-3600
Mailing Address - Fax:276-466-3578
Practice Address - Street 1:1883 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3605
Practice Address - Country:US
Practice Address - Phone:276-466-3600
Practice Address - Fax:276-466-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy