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General NPI Number Information
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NPI Number | 1568948693
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Entity Type | Individual
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Provider Name | BREANNE LEE DUNSWORTH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 150 WATERLOO COMMONS DR
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City | WATERLOO
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State | IL
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Zip | 62298-1060
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Country | US
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Telephone | 618-939-3942
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Fax | 618-939-3943
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Provider Business Mailing Address
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Address Line | 1542 ROSEWOOD TERRACE DR
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City | BALLWIN
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State | MO
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Zip | 63021-8464
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Country | US
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Telephone | 314-221-8193
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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 | 2016000201
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.299363
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License Number State | IL
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