Healthcare Provider Details

I. General information

NPI: 1609792449
Provider Name (Legal Business Name): BRIAN JEFFREY ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S GEAR AVE STE 105
WEST BURLINGTON IA
52655-1690
US

IV. Provider business mailing address

1223 S GEAR AVE STE 105
WEST BURLINGTON IA
52655-1690
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3950
  • Fax: 319-768-3955
Mailing address:
  • Phone: 319-768-3950
  • Fax: 319-768-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18005
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: