Healthcare Provider Details

I. General information

NPI: 1174677793
Provider Name (Legal Business Name): BRANDI PAPPAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N ROCK RD
DERBY KS
67037-3735
US

IV. Provider business mailing address

1101 N ROCK RD
DERBY KS
67037-3735
US

V. Phone/Fax

Practice location:
  • Phone: 316-788-6669
  • Fax: 316-788-3570
Mailing address:
  • Phone: 316-788-6669
  • Fax: 316-788-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number14-01838
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: