Provider Demographics
NPI:1285964379
Name:BUNDU-KAMARA, SAMUEL (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:BUNDU-KAMARA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2705
Mailing Address - Country:US
Mailing Address - Phone:520-458-5638
Mailing Address - Fax:
Practice Address - Street 1:1950 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2705
Practice Address - Country:US
Practice Address - Phone:520-458-5638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist