Individual
MRS. KELLIE JUNE BRUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
415 W MAIN ST, GRANGEVILLE, ID 83530
(208) 983-0725
(208) 983-9534
Mailing address
539 RESERVATION LINE RD, COTTONWOOD, ID 83522
(208) 962-5542
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4886
ID
Other
Enumeration date
08/29/2006
Last updated
07/08/2007
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