Provider Demographics
NPI:1275179186
Name:KAISER, BRENT L (RPH)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:L
Last Name:KAISER
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 1:2211 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3719
Mailing Address - Country:US
Mailing Address - Phone:574-269-6674
Mailing Address - Fax:574-267-5094
Practice Address - Street 1:2211 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3719
Practice Address - Country:US
Practice Address - Phone:574-269-6674
Practice Address - Fax:574-267-5094
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014323A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist