Provider Demographics
NPI:1255520011
Name:BRUNER, ALISSA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:MARIE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3103
Mailing Address - Country:US
Mailing Address - Phone:660-747-9171
Mailing Address - Fax:660-747-2022
Practice Address - Street 1:509 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3103
Practice Address - Country:US
Practice Address - Phone:660-747-9171
Practice Address - Fax:660-747-2022
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003020521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist