Healthcare Provider Details

I. General information

NPI: 1306774039
Provider Name (Legal Business Name): BRANDON MILLARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S
EDINA MN
55435-4534
US

IV. Provider business mailing address

7373 FRANCE AVE S
EDINA MN
55435-4534
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-0690
  • Fax:
Mailing address:
  • Phone: 952-428-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number119745
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: