Healthcare Provider Details

I. General information

NPI: 1164955845
Provider Name (Legal Business Name): MR. JOHN BRAUNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E MAIN ST
CHILLICOTHEE OH
45601-2506
US

IV. Provider business mailing address

75 MAPLE GROVE RD
CHILLICOTHEE OH
45601-9150
US

V. Phone/Fax

Practice location:
  • Phone: 740-774-2670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03212502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: