Provider Demographics
NPI:1518376748
Name:MAGRUDER, BRENDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:
Last Name:MAGRUDER
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 1:17811 E US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-1164
Mailing Address - Country:US
Mailing Address - Phone:816-257-5202
Mailing Address - Fax:
Practice Address - Street 1:17811 E US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-1164
Practice Address - Country:US
Practice Address - Phone:816-257-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014028384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist