Active NPI
John Steven Brunson, RPH
- Pharmacist
- Tyler, TX
National Provider Identifier
1124644141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 23663
- Practice address
- 2020 Roseland Blvd
Tyler, TX 75701-4248 - Phone
- (903) 597-1358
- NPI assigned
- Jun 25, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 23663 | TX | Primary |
Addresses
Primary practice location
2020 Roseland Blvd
Tyler, TX 75701-4248
Mailing address
1347 Santa Fe TRL
Tyler, TX 75703-0414
Phone (409) 673-4607
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23663 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593043200000",
"number": "1124644141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1347 SANTA FE TRL",
"city": "TYLER",
"state": "TX",
"postal_code": "757030414",
"telephone_number": "409-673-4607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 ROSELAND BLVD",
"city": "TYLER",
"state": "TX",
"postal_code": "757014248",
"telephone_number": "903-597-1358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNSON",
"first_name": "JOHN",
"middle_name": "STEVEN",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-25",
"last_updated": "2020-06-25",
"certification_date": "2020-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "23663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.