Provider Demographics
NPI:1881109312
Name:BRUNNER ENTERPRISES INC
Entity type:Organization
Organization Name:BRUNNER ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:970-842-2416
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:CO
Mailing Address - Zip Code:80720-0306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:149 MAIN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:CO
Practice Address - Zip Code:80720-1441
Practice Address - Country:US
Practice Address - Phone:970-514-4433
Practice Address - Fax:970-514-4435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-06
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
COOO00006073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000161377Medicaid