1770585572 NPI number — BUNTE'S PHARMACY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770585572 NPI number — BUNTE'S PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUNTE'S PHARMACY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770585572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 E MAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEELAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49464-1735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-772-4685
Provider Business Mailing Address Fax Number:
616-772-9526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 E MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEELAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49464-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-772-4685
Provider Business Practice Location Address Fax Number:
616-772-9526
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VANDE BUNTE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT, PHARMACIST IN CHARGE
Authorized Official Telephone Number:
616-772-4685

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302023342 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301000358 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2309018 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2309018 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5301000358 . This is a "PHARMACY LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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