Provider Demographics
NPI:1396299715
Name:BUNCE, YOLANDA PATRICIA (RPH)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:PATRICIA
Last Name:BUNCE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-3212
Mailing Address - Country:US
Mailing Address - Phone:903-758-8286
Mailing Address - Fax:
Practice Address - Street 1:1900 S HIGH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-3212
Practice Address - Country:US
Practice Address - Phone:903-758-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36831183500000X
GA20087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist