Healthcare Provider Details

I. General information

NPI: 1811617285
Provider Name (Legal Business Name): TERESA BRUNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S SMITHVILLE RD
DAYTON OH
45403-3421
US

IV. Provider business mailing address

7574 WOODBRIDGE CT
SPRINGBORO OH
45066-9192
US

V. Phone/Fax

Practice location:
  • Phone: 937-252-2839
  • Fax:
Mailing address:
  • Phone: 937-371-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03219431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: