Provider Demographics
NPI:1336424712
Name:PUNTURIERE, VINCENT (RPH)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:PUNTURIERE
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 1:15267 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2030
Mailing Address - Country:US
Mailing Address - Phone:586-294-5463
Mailing Address - Fax:586-294-5856
Practice Address - Street 1:15267 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2030
Practice Address - Country:US
Practice Address - Phone:586-294-5463
Practice Address - Fax:586-294-5856
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist