Provider Demographics
NPI:1073642427
Name:BRAUN, BRENDA KAY
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAY
Last Name:BRAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 N STATE ROAD 161
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47634-9553
Mailing Address - Country:US
Mailing Address - Phone:812-359-5393
Mailing Address - Fax:
Practice Address - Street 1:509 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1429
Practice Address - Country:US
Practice Address - Phone:812-649-2227
Practice Address - Fax:812-649-3253
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67000172A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6700172AOtherSTATE LICENSE