Provider Demographics
NPI:1508138157
Name:VAKINER, BRANDON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:VAKINER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-8646
Mailing Address - Country:US
Mailing Address - Phone:319-499-1005
Mailing Address - Fax:
Practice Address - Street 1:1382 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-8646
Practice Address - Country:US
Practice Address - Phone:319-499-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20192183500000X
NE13565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist