Provider Demographics
NPI:1396955845
Name:BRUNNER, KAY YVONNE (RPH PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:YVONNE
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:RPH PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 S C ST
Mailing Address - Street 2:
Mailing Address - City:HERINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67449-3016
Mailing Address - Country:US
Mailing Address - Phone:785-258-3717
Mailing Address - Fax:785-258-9013
Practice Address - Street 1:11 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HERINGTON
Practice Address - State:KS
Practice Address - Zip Code:67449-2401
Practice Address - Country:US
Practice Address - Phone:785-258-3717
Practice Address - Fax:785-258-9013
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-10366OtherKANSAS PHARMACIST LICENSE