Provider Demographics
NPI:1790181717
Name:BRUNKO, JASON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:BRUNKO
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 1:24350 WENNERSBORG RD SW
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56343
Mailing Address - Country:US
Mailing Address - Phone:651-428-8187
Mailing Address - Fax:
Practice Address - Street 1:241 W HIGHWAY 210
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:MN
Practice Address - Zip Code:55760-5009
Practice Address - Country:US
Practice Address - Phone:218-768-4165
Practice Address - Fax:218-768-3404
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist