Healthcare Provider Details

I. General information

NPI: 1831529353
Provider Name (Legal Business Name): BRUNSWIG PHARMACY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E. PEARL
DIGHTON KS
67839
US

IV. Provider business mailing address

PO BOX 607
DIGHTON KS
67839-0607
US

V. Phone/Fax

Practice location:
  • Phone: 620-397-5778
  • Fax: 620-397-2990
Mailing address:
  • Phone: 620-397-5778
  • Fax: 620-397-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number115839
License Number StateKS

VIII. Authorized Official

Name: JONATHAN BRUNSWIG
Title or Position: OWNER
Credential:
Phone: 620-397-5778