Provider Demographics
NPI:1285968305
Name:BUNCEK, HENRY JOSEPH
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:JOSEPH
Last Name:BUNCEK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:HANK
Other - Middle Name:JOSEPH
Other - Last Name:BUNCEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:76 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1422
Mailing Address - Country:US
Mailing Address - Phone:732-381-1133
Mailing Address - Fax:732-381-7191
Practice Address - Street 1:76 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1422
Practice Address - Country:US
Practice Address - Phone:732-381-1133
Practice Address - Fax:732-381-7191
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01287900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01287900IOtherBOARD OF PHARMACY