Healthcare Provider Details

I. General information

NPI: 1356331722
Provider Name (Legal Business Name): MICHAEL L BRANDT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

IV. Provider business mailing address

6331 S SADDLE RIDGE RD
GREENACRES WA
99016-8726
US

V. Phone/Fax

Practice location:
  • Phone: 208-666-3335
  • Fax: 208-666-2169
Mailing address:
  • Phone: 208-659-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00018107
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: