Provider Demographics
NPI:1689664617
Name:PUNDT, GARY WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:PUNDT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3646
Mailing Address - Country:US
Mailing Address - Phone:507-288-6463
Mailing Address - Fax:507-288-2192
Practice Address - Street 1:202 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3646
Practice Address - Country:US
Practice Address - Phone:507-288-6463
Practice Address - Fax:507-288-2192
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115189-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115189-3OtherMN BOARD OF PHARMACY LIC.