Healthcare Provider Details

I. General information

NPI: 1922750769
Provider Name (Legal Business Name): BRADLEY JOHN HREN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 GRAND AVE
DULUTH MN
55807-2737
US

IV. Provider business mailing address

4212 GRAND AVE
DULUTH MN
55807-2737
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3700
  • Fax: 218-786-3705
Mailing address:
  • Phone: 218-786-3700
  • Fax: 218-786-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116042
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: