Provider Demographics
NPI:1285901181
Name:BRUNS, JORDAN MICHAEL (RPH, PHARMD)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:BRUNS
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-2037
Mailing Address - Country:US
Mailing Address - Phone:319-270-4849
Mailing Address - Fax:515-727-7938
Practice Address - Street 1:10607 AURORA AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7927
Practice Address - Country:US
Practice Address - Phone:515-727-7937
Practice Address - Fax:515-727-7938
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21898183500000X
WI16085-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist