Provider Demographics
NPI:1790802700
Name:BANWARTH, BRANDEE N (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRANDEE
Middle Name:N
Last Name:BANWARTH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BOYSON RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7284
Mailing Address - Country:US
Mailing Address - Phone:319-294-8095
Mailing Address - Fax:319-294-1340
Practice Address - Street 1:505 BOYSON RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7284
Practice Address - Country:US
Practice Address - Phone:319-294-8095
Practice Address - Fax:319-294-1340
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist