Provider Demographics
NPI:1144781881
Name:TARWATER, BRANDON LEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:TARWATER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2352
Mailing Address - Country:US
Mailing Address - Phone:316-941-4427
Mailing Address - Fax:316-941-4086
Practice Address - Street 1:6200 W KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2352
Practice Address - Country:US
Practice Address - Phone:316-941-4427
Practice Address - Fax:316-941-4086
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR-14233183500000X
KS1-14423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist