Provider Demographics
NPI:1528393931
Name:BRAUNER, LYLE DANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:DANIEL
Last Name:BRAUNER
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 1:8021 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5867
Mailing Address - Country:US
Mailing Address - Phone:602-242-9570
Mailing Address - Fax:
Practice Address - Street 1:8021 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5867
Practice Address - Country:US
Practice Address - Phone:602-242-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist