Provider Demographics
NPI:1780272849
Name:GUND, MICHAEL LEE (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:GUND
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 1:1404 WEST 211 BYPASS
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835
Mailing Address - Country:US
Mailing Address - Phone:540-743-4529
Mailing Address - Fax:
Practice Address - Street 1:1404 WEST 211 BYPASS
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835
Practice Address - Country:US
Practice Address - Phone:540-743-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist