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General NPI Number Information
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NPI Number | 1053059501
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Entity Type | Individual
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Provider Name | BRENDEN WATAMANIUK PHARMD, RPH
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Gender | Male
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 12010 W 63RD ST
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City | SHAWNEE
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State | KS
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Zip | 66216-1867
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Country | US
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Telephone | 913-268-8150
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Fax |
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Provider Business Mailing Address
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Address Line | 17270 W 86TH TER APT 12301
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City | LENEXA
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State | KS
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Zip | 66219-7101
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Country | US
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Telephone | 913-426-5720
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1-103790
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License Number State | KS
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