Healthcare Provider Details

I. General information

NPI: 1598537300
Provider Name (Legal Business Name): MICHAEL BRAUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 THIERMAN LN
ST MATTHEWS KY
40207-5009
US

IV. Provider business mailing address

2846 SANDALWOOD DR
NEW ALBANY IN
47150-9464
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-8110
  • Fax:
Mailing address:
  • Phone: 502-939-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number016022
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: