Provider Demographics
NPI:1952880783
Name:PUN, ANDREW MICHAEL
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:PUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 DOUGLAS ST APT 1401
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1282
Mailing Address - Country:US
Mailing Address - Phone:515-528-3577
Mailing Address - Fax:
Practice Address - Street 1:1802 GALVIN RD S
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3813
Practice Address - Country:US
Practice Address - Phone:402-291-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE161761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist