Healthcare Provider Details

I. General information

NPI: 1043581663
Provider Name (Legal Business Name): VYKE BREEN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 PACIFIC AVE
BENSON MN
56215-1838
US

IV. Provider business mailing address

1207 PACIFIC AVE
BENSON MN
56215-1838
US

V. Phone/Fax

Practice location:
  • Phone: 320-842-4221
  • Fax: 320-842-5231
Mailing address:
  • Phone: 320-842-4221
  • Fax: 320-842-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113242
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: