Bradley Todd Kunkel, RPH
Individual provider Active NPI Pharmacist · Kearney, MO
NPI 1356525539 · NPPES record last updated Dec 24, 2007
Key facts
- NPI
- 1356525539
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 042756 (MO)
- Practice address
- 101 W 92 Hwy
Ste. a Red Cross Pharmacy
Kearney, MO 64060-7591 - Phone
- (816) 635-4485
- Fax
- (816) 628-4649
- NPI assigned
- Dec 24, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042756 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 042756 | MO | Yes |
Addresses
Primary practice location
101 W 92 Hwy
Ste. a Red Cross Pharmacy
Kearney, MO 64060-7591
Mailing address
101 West 92 Hwy
Red Cross Pharmacy
Kearney, MO 64068-7591
Phone (816) 635-4485
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60005908 | Medicaid | MO |
Other providers in Kearney, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 24, 2007. 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.