Provider Demographics
NPI:1548437015
Name:PUNI, ROBERT KOJO
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KOJO
Last Name:PUNI
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 1:111 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-3120
Mailing Address - Country:US
Mailing Address - Phone:330-412-5948
Mailing Address - Fax:
Practice Address - Street 1:24801 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3487
Practice Address - Country:US
Practice Address - Phone:440-979-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-27626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist