Provider Demographics
NPI:1356525539
Name:KUNKEL, BRADLEY TODD (RPH)
Entity type:Individual
Prefix:MISS
First Name:BRADLEY
Middle Name:TODD
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WEST 92 HWY
Mailing Address - Street 2:RED CROSS PHARMACY
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-7591
Mailing Address - Country:US
Mailing Address - Phone:816-635-4485
Mailing Address - Fax:816-628-4649
Practice Address - Street 1:101 W 92 HWY
Practice Address - Street 2:STE. A RED CROSS PHARMACY
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7591
Practice Address - Country:US
Practice Address - Phone:816-635-4485
Practice Address - Fax:816-628-4649
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO60005908Medicaid