Provider Demographics
NPI:1588065825
Name:BRNCIK, PAUL JR
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BRNCIK
Suffix:JR
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 1:2961 E VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-6200
Mailing Address - Country:US
Mailing Address - Phone:602-740-7367
Mailing Address - Fax:
Practice Address - Street 1:2961 VERNON AVE
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-6200
Practice Address - Country:US
Practice Address - Phone:602-740-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist