Provider Demographics
NPI:1487939062
Name:GUNDA, PANDU R
Entity type:Individual
Prefix:MR
First Name:PANDU
Middle Name:R
Last Name:GUNDA
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 1:2815 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-3927
Mailing Address - Country:US
Mailing Address - Phone:810-234-0317
Mailing Address - Fax:
Practice Address - Street 1:2815 DAVISON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3927
Practice Address - Country:US
Practice Address - Phone:810-234-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist