1336222082 NPI number — BRAD KANDER PHARMD

Table of content: BRAD KANDER PHARMD (NPI 1336222082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336222082 NPI number — BRAD KANDER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANDER
Provider First Name:
BRAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336222082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 NW VALLEYBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73505-9567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 MOW-WAY ROAD
Provider Second Line Business Practice Location Address:
REYNOLDS ARMY COMMUNITY HOSPITAL (ATTN: MCUA-QC, MS. PR
Provider Business Practice Location Address City Name:
FORT SILL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73503-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-458-2134
Provider Business Practice Location Address Fax Number:
580-458-2314
Provider Enumeration Date:
10/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  11231 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)