Healthcare Provider Details

I. General information

NPI: 1689890220
Provider Name (Legal Business Name): KATHLEEN ALICE BRAUEN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OHIO ST
MEDINA NY
14103-1063
US

IV. Provider business mailing address

4220 ORANGEPORT RD
GASPORT NY
14067-9251
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-2000
  • Fax: 585-798-8066
Mailing address:
  • Phone: 716-289-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: