Provider Demographics
NPI:1689716805
Name:PUNT, GORDON W (RPH)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:W
Last Name:PUNT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 E MAGNOLIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3417
Mailing Address - Country:US
Mailing Address - Phone:352-357-4341
Mailing Address - Fax:352-357-5107
Practice Address - Street 1:2 E MAGNOLIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3417
Practice Address - Country:US
Practice Address - Phone:352-357-4341
Practice Address - Fax:352-357-5107
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPS 37562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist