Healthcare Provider Details

I. General information

NPI: 1710085311
Provider Name (Legal Business Name): BRUNSWIG PHARMACY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W BROADWAY
LEOTI KS
67861-7019
US

IV. Provider business mailing address

111 W BROADWAY
LEOTI KS
67861-7019
US

V. Phone/Fax

Practice location:
  • Phone: 620-375-2323
  • Fax:
Mailing address:
  • Phone: 620-375-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12443
License Number StateKS

VIII. Authorized Official

Name: DR. JONATHAN WAYNE BRUNSWIG
Title or Position: OWNER/STAFF PHARMACIST
Credential: PHARMD
Phone: 620-375-2323