Provider Demographics
NPI:1821345109
Name:BRUNKE, KERI LYNNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LYNNE
Last Name:BRUNKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:LYNNE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3333 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2050
Mailing Address - Country:US
Mailing Address - Phone:719-589-9021
Mailing Address - Fax:719-589-9023
Practice Address - Street 1:3333 CLARK ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2050
Practice Address - Country:US
Practice Address - Phone:719-589-9021
Practice Address - Fax:719-589-9023
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist