Provider Demographics
NPI:1619507704
Name:BRUN, JOSHUA CHRISTIAN (RPH)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CHRISTIAN
Last Name:BRUN
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 1:720 MERCER PL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2643
Mailing Address - Country:US
Mailing Address - Phone:704-564-3288
Mailing Address - Fax:
Practice Address - Street 1:274 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2528
Practice Address - Country:US
Practice Address - Phone:704-664-3469
Practice Address - Fax:704-664-5596
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist