Provider Demographics
NPI:1255914180
Name:SCOTT CITY PHARMACY CHARTERED
Entity type:Organization
Organization Name:SCOTT CITY PHARMACY CHARTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BRUNSWIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:620-214-1160
Mailing Address - Street 1:102 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-7102
Mailing Address - Country:US
Mailing Address - Phone:620-872-2146
Mailing Address - Fax:620-872-7099
Practice Address - Street 1:102 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-7102
Practice Address - Country:US
Practice Address - Phone:620-872-2146
Practice Address - Fax:620-872-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2024-06-03
Deactivation Date:2023-10-25
Deactivation Code:
Reactivation Date:2024-06-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy