Healthcare Provider Details

I. General information

NPI: 1396955845
Provider Name (Legal Business Name): KAY YVONNE BRUNNER RPH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N BROADWAY
HERINGTON KS
67449-2401
US

IV. Provider business mailing address

418 S C ST
HERINGTON KS
67449-3016
US

V. Phone/Fax

Practice location:
  • Phone: 785-258-3717
  • Fax: 785-258-9013
Mailing address:
  • Phone: 785-258-3717
  • Fax: 785-258-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-10366
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: