MEDICARE: AMY M BRINER R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	42736	MO

General Provider Information

NPI Number	:	1356420525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY M BRINER R.PH.

Provider Business Mailing Address
First Line	:	23615 S GREENRIDGE RD
Second Line	:
City	:	PECULIAR
State	:	MO
Zip	:	64078-8836
Country	:	US
Telephone Number	:	816-779-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 N MAIN ST
Second Line	:
City	:	PECULIAR
State	:	MO
Zip	:	64078-2522
Country	:	US
Telephone Number	:	816-779-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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