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General NPI Number Information
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NPI Number | 1710085311
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Entity Type | Organization
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Legal Business Name | BRUNSWIG PHARMACY, PA
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 111 W BROADWAY
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City | LEOTI
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State | KS
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Zip | 67861-7019
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Country | US
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Telephone | 620-375-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 111 W BROADWAY
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City | LEOTI
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State | KS
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Zip | 67861-7019
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Country | US
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Telephone | 620-375-2323
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Fax |
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Authorized Official
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Title or Position | OWNER/STAFF PHARMACIST
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Name | DR. JONATHAN WAYNE BRUNSWIG
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Credential | PHARMD
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Telephone | 620-375-2323
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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 | 12443
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License Number State | KS
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