Healthcare Provider Details

I. General information

NPI: 1629008446
Provider Name (Legal Business Name): CHARLES BRUNER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 2ND ST SW HSC(K), RM B732
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

3714 THOMASSON CROSSING DR
TRIANGLE VA
22172-2023
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-4109
  • Fax: 202-372-4912
Mailing address:
  • Phone: 703-445-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH35660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: