Healthcare Provider Details

I. General information

NPI: 1881109312
Provider Name (Legal Business Name): BRUNNER ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 MAIN AVE
AKRON CO
80720-1441
US

IV. Provider business mailing address

PO BOX 307
AKRON CO
80720-0306
US

V. Phone/Fax

Practice location:
  • Phone: 970-514-4433
  • Fax: 970-514-4435
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberOO0000607
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9000161377
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: DR. BENJAMIN BRUNNER
Title or Position: OWNER
Credential: PHARMD
Phone: 970-842-2416