MEDICARE: BRUNER DRUGS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	005892	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2049616	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629025127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUNER DRUGS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-0009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 S MAIN ST
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834
Country	:	US
Telephone Number	:	417-649-7021
Fax Number	:	417-649-6269

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERRY BOTTS
Credential	:
Telephone Number	:	417-649-7021

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/24/2018

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Directions to “BRUNER DRUGS, INC. ” Practice Location

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