MEDICARE: DR. BRANDON CORPENING PHARMD

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	1-117634	KS
2	183500000X	Pharmacist	051301885	IL
3	183500000X	Pharmacist	0202211411	VA
4	183500000X	Pharmacist	2015036083	MO

General Provider Information

NPI Number	:	1376982090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON CORPENING PHARMD

Provider Business Mailing Address
First Line	:	5742 GREY DOVE PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3778
Country	:	US
Telephone Number	:	404-593-9305
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 PARK AVE STE 155
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2512
Country	:	US
Telephone Number	:	314-897-5002
Fax Number	:

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

Provider Enumeration Date	:	06/15/2013
Last Update Date	:	09/26/2022

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Directions to “ DR. BRANDON CORPENING PHARMD” Practice Location

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