Provider Demographics
NPI:1861484552
Name:BRUNSCHEON, JOHN H (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:BRUNSCHEON
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:PO BOX 1042
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-1042
Mailing Address - Country:US
Mailing Address - Phone:503-631-8085
Mailing Address - Fax:
Practice Address - Street 1:1525 W MAIN ST
Practice Address - Street 2:SAFEWAY PHARMACY #1751
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-7362
Practice Address - Country:US
Practice Address - Phone:503-829-4855
Practice Address - Fax:503-829-4780
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6151OtherOR BOARD OF PHARMACY LIC
OR6151OtherBOARD OF PHARMACY LICENSE