Provider Demographics
NPI:1275815912
Name:PUNDMANN, IRENE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:PUNDMANN
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 1:2310 S OLD HIGHWAY 94
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5622
Mailing Address - Country:US
Mailing Address - Phone:636-477-7996
Mailing Address - Fax:636-477-8639
Practice Address - Street 1:2310 S OLD HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5622
Practice Address - Country:US
Practice Address - Phone:636-477-7996
Practice Address - Fax:636-477-8639
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist