Healthcare Provider Details

I. General information

NPI: 1588071252
Provider Name (Legal Business Name): SAMANTHA LEE BRUTON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA LEE PATTON PHARM.D.

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 N ROCK RD
DERBY KS
67037-3718
US

IV. Provider business mailing address

1624 N ROCK RD
DERBY KS
67037-3718
US

V. Phone/Fax

Practice location:
  • Phone: 316-554-2121
  • Fax: 316-554-2125
Mailing address:
  • Phone: 316-554-2121
  • Fax: 316-554-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1-16007
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16007
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: