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General NPI Number Information
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NPI Number | 1952762643
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Entity Type | Individual
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Provider Name | TIMOTHY S BROADERWAY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 1000 ADAMS ST
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City | GREAT BEND
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State | KS
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Zip | 67530-4208
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Country | US
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Telephone | 620-792-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 ELIZABETH DR
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City | ELLSWORTH
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State | KS
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Zip | 67439-2328
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Country | US
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Telephone | 785-472-2193
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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 | 1-17189
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License Number State | KS
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