MEDICARE: BRAYDEN MICHAEL LEAKE PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHA-PHA-LIC-117782	MT

General Provider Information

NPI Number	:	1336016971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAYDEN MICHAEL LEAKE PHARM.D.

Provider Business Mailing Address
First Line	:	207 RIVER ST
Second Line	:	PO BOX 1157
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9673
Country	:	US
Telephone Number	:	406-822-4681
Fax Number	:	406-822-0057

Provider Business Practice Location Address
First Line	:	207 RIVER ST
Second Line	:	PO BOX 1157
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9673
Country	:	US
Telephone Number	:	406-822-4681
Fax Number	:	406-822-0057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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