Brant Donald Hanisch, PHARM.D.
Individual provider Active NPI Pharmacist · Shenandoah, IA
NPI 1730705187 · NPPES record last updated Jun 22, 2020
Key facts
- NPI
- 1730705187
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 20982 (IA)
- Practice address
- 705 S Fremont St
Shenandoah, IA 51601-1570 - Phone
- (712) 246-4033
- Fax
- (712) 246-1101
- NPI assigned
- Jun 22, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 20982 | IA | MD | Pharmacist |
| 2008028041 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past |
Accepting new patients | |
| Walmart Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2008028041 | MO | |
| Pharmacist | 183500000X | 20982 | IA | Yes |
Addresses
Primary practice location
705 S Fremont St
Shenandoah, IA 51601-1570
Mailing address
1592 A Ave
Essex, IA 51638-6019
Phone (712) 215-1810
Other providers in Shenandoah, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2020. 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.