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General NPI Number Information
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NPI Number | 1023385226
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Entity Type | Individual
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Provider Name | BRANDON UTTER PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 4101 S 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5014
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Country | US
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Telephone | 785-218-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 9139 DR KORCZAK TER
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City | SKOKIE
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State | IL
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Zip | 60076-1746
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Country | US
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Telephone | 785-218-1415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 1-15451
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 03440500
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License Number State | OH
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