Provider Demographics
NPI:1588641161
Name:BRUNER, JOHN MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BRUNER
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 1:8 GREENRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-2809
Mailing Address - Country:US
Mailing Address - Phone:417-235-7047
Mailing Address - Fax:417-235-8058
Practice Address - Street 1:321 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-2329
Practice Address - Country:US
Practice Address - Phone:417-235-3139
Practice Address - Fax:417-235-8058
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2602236OtherPROVIDER NUMBER NABP #
MO600093801Medicaid