Provider Demographics
NPI:1306431002
Name:BUNTING, TRAVIS WILLIAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:WILLIAM
Last Name:BUNTING
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 1:1401 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501
Mailing Address - Country:US
Mailing Address - Phone:620-663-7681
Mailing Address - Fax:620-663-4407
Practice Address - Street 1:1401 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501
Practice Address - Country:US
Practice Address - Phone:620-663-7681
Practice Address - Fax:620-663-4407
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-109540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100944850-AMedicaid