Provider Demographics
NPI:1396833612
Name:PUNCH, ROBERT M (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:PUNCH
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 1:208 IVY SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8194
Mailing Address - Country:US
Mailing Address - Phone:803-419-2447
Mailing Address - Fax:
Practice Address - Street 1:10 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6892
Practice Address - Country:US
Practice Address - Phone:803-494-6449
Practice Address - Fax:803-434-6448
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11163183500000X
NC17047183500000X
GA21351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA21351OtherPHARMACIST LICENSE
NC17047OtherPHARMACIST LICENSE
SC11163OtherPHARMACIST LICENSE