Provider Demographics
NPI:1649633249
Name:HUNINGAHKE, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HUNINGAHKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 MARTWAY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202
Mailing Address - Country:US
Mailing Address - Phone:913-831-4477
Mailing Address - Fax:913-831-9263
Practice Address - Street 1:6655 MARTWAY ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3290
Practice Address - Country:US
Practice Address - Phone:913-831-4477
Practice Address - Fax:913-831-9263
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14894183500000X
MO2015042269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist