Maynard David Brothersen, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

16463 Issued in IA

Practice address

2660 E 53Rd St
Suite 1
Davenport, IA 52807-3873

Phone

(563) 388-1887

NPI assigned

Feb 4, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447398995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2827 FARNAM ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528031601",
            "telephone_number": "563-324-5218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2660 E 53RD ST",
            "address_2": "SUITE 1",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073873",
            "telephone_number": "563-388-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTHERSEN",
        "first_name": "MAYNARD",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "16463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Davenport, IA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.