1285901181 NPI number — MR. JORDAN MICHAEL BRUNS RPH, PHARMD

Table of content: MR. JORDAN MICHAEL BRUNS RPH, PHARMD (NPI 1285901181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285901181 NPI number — MR. JORDAN MICHAEL BRUNS RPH, PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNS
Provider First Name:
JORDAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH, 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:
1285901181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3550 SW 29TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50321-2037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-270-4849
Provider Business Mailing Address Fax Number:
515-727-7938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10607 AURORA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANDALE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50322-7927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-727-7937
Provider Business Practice Location Address Fax Number:
515-727-7938
Provider Enumeration Date:
11/19/2011

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:  21898 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 16085-040 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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