Healthcare Provider Details

I. General information

NPI: 1265601280
Provider Name (Legal Business Name): MIKEL JON BRANDHORST PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2008
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 UNION ST
BOONE IA
50036-4821
US

IV. Provider business mailing address

1015 UNION ST
BOONE IA
50036-4821
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-3140
  • Fax:
Mailing address:
  • Phone: 515-432-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20343
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: