Provider Demographics
NPI:1457906778
Name:BRUNER, LINDSEY MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
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 1:157 OLD FLOWING WELL RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-3149
Mailing Address - Country:US
Mailing Address - Phone:229-854-4827
Mailing Address - Fax:
Practice Address - Street 1:2715 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1673
Practice Address - Country:US
Practice Address - Phone:229-431-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist