Individual
MR. MAYNARD DAVID BROTHERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2660 E 53RD ST, SUITE 1, DAVENPORT, IA 52807-3873
(563) 388-1887
Mailing address
2827 FARNAM ST, DAVENPORT, IA 52803-1601
(563) 324-5218
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16463
IA
Other
Enumeration date
02/04/2007
Last updated
07/08/2007
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