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1720290224 NPI number — MICKIE S. BRUNNER PHARMD,, R.PH

NPI Number: 1720290224
Health Care Provider/Practitioner: MICKIE S. BRUNNER PHARMD,, R.PH

Information about “1720290224” NPI (MICKIE S. BRUNNER PHARMD,, R.PH) exists in 1720290224 in HTML format HTML  |  1720290224 in plain Text format TXT  |  1720290224 in PDF (Portable Document Format) PDF  |  1720290224 in an XML format XML  formats.

NPI Number : 1720290224 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720290224",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRUNNER",
    "FirstName": "MICKIE",
    "MiddleName": "S.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD,, R.PH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TIMLIN",
    "OtherFirstName": "MICKIE",
    "OtherMiddleName": "S.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "214 W. RAINBOW DR.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLENWOOD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60425",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-754-6911",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "ONE INGALLS DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HARVEY",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60426",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-915-4420",
    "PracticeLocationAddressFaxNumber": "708-915-3108",
    "EnumerationDate": "05/04/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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