Provider Demographics
NPI:1790389963
Name:DUNAWAY, BRENT ROBERT (RPH)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ROBERT
Last Name:DUNAWAY
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 1:900 E BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3624
Mailing Address - Country:US
Mailing Address - Phone:574-206-8476
Mailing Address - Fax:574-206-1767
Practice Address - Street 1:900 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3624
Practice Address - Country:US
Practice Address - Phone:574-206-8476
Practice Address - Fax:574-206-1767
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025425A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist