Jonathan Wayne Brunswig, PHARMD
Individual provider Active NPI Pharmacist · Scott City, KS
NPI 1174065064 · NPPES record last updated Nov 9, 2016
Key facts
- NPI
- 1174065064
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 12443 (KS)
- Practice address
- 102 Albert Ave
Scott City, KS 67871-6122 - Phone
- (620) 214-1160
- Fax
- (620) 872-7099
- NPI assigned
- Nov 9, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12443 | KS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scott City Pharmacy Chartered | Current |
Accepting new patients | |
| Scott City Pharmacy | Pharmacist | Current | Accepting new patients |
Locations
102 Albert Ave
Scott City, KS 67871
Phone (620) 872-2146
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12443 | KS | Yes |
Addresses
Primary practice location
102 Albert Ave
Scott City, KS 67871-6122
Mailing address
102 Albert Ave
Scott City, KS 67871-6122
Phone (620) 214-1160
Other providers in Scott City, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.